Systems in Acute Stroke Care Andy Jagoda, MD Professor of Emergency Medicine Department of Emergency Medicine Mount Sinai School of Medicine New York, NY Kevin Baumlin, MD Department of Emergency Medicine Mount Sinai School of Medicine New York, NY - PowerPoint PPT Presentation

1 / 11
About This Presentation
Title:

Systems in Acute Stroke Care Andy Jagoda, MD Professor of Emergency Medicine Department of Emergency Medicine Mount Sinai School of Medicine New York, NY Kevin Baumlin, MD Department of Emergency Medicine Mount Sinai School of Medicine New York, NY

Description:

'Hospitals must develop comprehensive acute stroke plans that define the ... LASS. Rapid Transportation. Lights and Sirens? ED Notification. Andy Jagoda, MD ... – PowerPoint PPT presentation

Number of Views:674
Avg rating:3.0/5.0
Slides: 12
Provided by: uic9
Category:

less

Transcript and Presenter's Notes

Title: Systems in Acute Stroke Care Andy Jagoda, MD Professor of Emergency Medicine Department of Emergency Medicine Mount Sinai School of Medicine New York, NY Kevin Baumlin, MD Department of Emergency Medicine Mount Sinai School of Medicine New York, NY


1
Systems in Acute Stroke Care Andy Jagoda,
MDProfessor of Emergency MedicineDepartment of
Emergency MedicineMount Sinai School of
MedicineNew York, NY Kevin Baumlin,
MDDepartment of Emergency MedicineMount Sinai
School of MedicineNew York, NY
2
Introduction
  • Hospitals must develop comprehensive acute
    stroke plans that define the specialized roles of
    nursing staff, diagnostic units, stroke teams,
    and other treatment services . . ..
  • National Institute of Neurological Disorders and
    Stroke (NINDS), 1996
  • Multidisciplinary group, 50 organizations

3
Introduction
  • Narrow therapeutic window
  • tPA within three hours of symptom onset
  • Rapid identification, transport, diagnosis and
    treatment
  • Stroke chain of survival (AHA)

4
Emergency Medical Services (EMS)
  • Dispatch to Door Time
  • Little training, variable knowledge (Nassisi 00)
  • Early identification
  • Cincinnati Stroke Scale (Kohtari)
  • LASS
  • Rapid Transportation
  • Lights and Sirens?
  • ED Notification

5
Emergency Department Response
  • Door to Neuroimaging Time
  • EPs are ideal coordinators of acute stroke
    response
  • Expeditious triage and registration
  • Lab -turn around .45 minutes
  • Primary Stroke Center or Comprehensive stroke
    Center
  • (BAC, Alberts et. al, JAMA 2000)

6
Acute Stroke Team
  • One physician one health care provider
  • Familiar with thrombolytic protocol and able to
    mange potential complications
  • Response within 15 minute/available 24 hrs
  • Systems in place including
  • Communication with EMS prior to arrival
  • Neuroimaging within 25 minutes of ordering
  • Interpretation within 20 minutes of completion

7
Written Care Protocols
  • Thrombolytic use is effective WHEN guidelines are
    followed
  • (NINDS 95,STARS JAMA00, Chui..stroke 98)
  • Only 1-3 of stroke pts. are being treated
  • (STARS, Chui)
  • Less than 10 of those eligible (katzen ,00)
  • Failure to adhere to protocol increases morbidity
  • ICH rate may increase almost three times
  • (Katzan et al JAMA 2000)

8
Stroke Units
  • Shown to decrease morbidity and mortality
  • (Stroke Unit Trialists BMJ 97)
  • Prevent
  • Aspiration, DVT
  • Fever/infection UTI, pneumonia
  • Early mental and physical rehab
  • Transfer patients to hospitals with stroke units
    post stabilization

9
Other Services
  • Continuous Quality Improvement (CQI)
  • Track timing, short and long term outcomes
  • Reduce delays and enhance patient care
  • Tilley et al Arch Neurol 1997
  • Newell, Stroke 1998
  • Education Programs should be established
  • Community
  • Health care providers

10
11 element necessary for hospital to provide
acute stroke center
  • Acute stroke team available 24 hours a day
  • Written care protocols to ensure rapid
    recognition, diagnosis, and treatment
  • Emergency medical services integrated into the
    acute stroke team operations
  • Emergency department integrated into the acute
    stroke team
  • Stroke unit
  • Neurosurgical services available within 2 hours
  • Commitment from the institution
  • Neuroimaging performed and interpreted within 45
    minutes of patient arrival
  • Laboratory services with rapid turn around of
    tests
  • Quality improvement program including a database
    or registry
  • Continuing education program

11
Conclusions
  • tPA, within its narrow therapeutic window is
    currently the only accepted treatment for stroke
  • Intact care systems and protocols decrease
    morbidity and mortality of stroke patients
  • Conversely, lack of intact systems and protocols
    puts stroke patients at risk for unacceptably
    high complication rates
Write a Comment
User Comments (0)
About PowerShow.com