Barrow Stroke Program Receives Top Honors
At the International Stroke Conference in Houston, Texas, Barrow neurologists Dr. Michael Waters and Dr. Joni Clark accepted the Get With The Guidelines-Stroke Gold Plus Achievement Award with Target: Stroke Honor Roll Elite Plus on behalf of the institute.
The Gold Plus Achievement Award recognizes hospitals that for two or more consecutive years have had at least 85 percent adherence to all Get With The Guidelines achievement measures and 75 percent adherence to at least five of eight Get With The Guidelines-Stroke quality measures.
“Some of the metrics are concerned with the speed of which a patient is evaluated and treated, some are geared toward preventing a second stroke after the patient is discharged, and some are geared toward recovery,” said Dr. Waters, who serves as director of the Stroke Program at Barrow. “So, these quality metrics actually pepper the timeline from when a patient initially arrives at the hospital all the way through their post-hospital level of care.”
Target: Stroke Honor Roll Elite Plus, which was awarded to 270 other hospitals across the United States for 2016, is one of three new award levels developed by the American Stroke Association in an effort to reduce the time between a patient’s arrival at a hospital and treatment with tissue plasminogen activator (tPA).
Hospitals qualify for Honor Roll Elite Plus if 75 percent or more of ischemic stroke patients are treated with IV tPA within 60 minutes of arrival and if 50 percent or more are treated within 45 minutes. These hospitals must also have at least a Silver Get With The Guidelines-Stroke status.
When given promptly, tPA can save lives and reduce the long-term effects of ischemic strokes. The drug, which is given through an IV in the arm, works by dissolving the blood clot that caused the stroke and improving blood flow to the parts of the brain that are being deprived. According to the American Stroke Association, stroke is the fifth leading cause of death and the No. 1 cause of adult disability in the U.S.
“In the field, we have the saying that ‘time is brain,’ ” Dr. Waters said.
According to a study published in the journal Stroke that sought to quantify this phrase, the total number of neurons in the average human forebrain is estimated at 22 billion. Every hour that a stroke is left untreated results in the loss of 120 million neurons and accelerates aging of the brain by 3.6 years.
“Early on in a stroke, there are areas of the brain that need blood and oxygen but are not dead,” Dr. Waters said. “If I can restore circulation to those areas of the brain that are stunned but still alive, I might be able to save those neurons and save brain. If there is no restoration of blood flow, those areas will go on to die and impair function forever.”
While the American Stroke Association sets high standards for hospitals trying to achieve its top recognition status, Dr. Waters said he and others in the Barrow Stroke Program have set the bar even higher for themselves.
Stroke care here is a team sport.
-Dr. Michael Waters, Director of Barrow Stroke Program
Stroke Program Coordinator Allison Tucker collects data on all stroke patients not only for review by the American Stroke Association but also for review in a monthly meeting at Barrow.
“All of the key stakeholders are at the table,” Dr. Waters said. “Neuroimaging, laboratory medicine, the emergency department, vascular neurology, endovascular neurosurgery, and nursing are all represented there. Any quality metrics that may be faltering or declining are addressed as a group. We discuss what we can do better.”
For example, to improve laboratory processing times, blood samples from stroke patients are now sent to the lab in red canisters instead of standard canisters so that those samples are immediately prioritized.
“We’re always refining our processes and defining areas for quality improvement and then generating plans to effect those changes,” Dr. Waters said. “Stroke care here is a team sport.”