Highland Hospital receives NY State Designation as a Stroke Center
February 23, 2006
In its continuing effort to raise the level of quality of care for stroke patients, the New York State Department of Health has just designated Highland Hospital a Stroke Center.
This designation formally acknowledges Highland Hospital’s emergency department and in-patient capabilities in stroke evaluation, diagnosis, continuing treatment, and rehabilitation. The designation also recognizes Highland’s efforts in staff development and community awareness. Formal notice of the designation, which is based on an on-site visit and an extensive review of a highly detailed application, was received by the hospital on February 17, 2006.
“The Health Department has established a set of evidence-based clinical standards in stroke care and offers the Stroke Center designation only when all of these standards are put into action,” says Cindy Becker, vice president and chief operating officer. “The true beneficiaries of this designation are the many patients we serve and their families who will seek treatment here knowing they’ll receive the highest standard of care.”
Highland Hospital sees approximately 400 stroke patients a year – either new to the emergency department or who have suffered a stroke while already hospitalized.
The significance of the Stroke Center designation to a community hospital such as Highland Hospital is its recognition of an on-going commitment the hospital made to meet the 31 designation criteria, which include a hospital’s demonstrated ability to:
- Establish communication protocols with area EMS services.
- Activate a stroke team so it is at a patient’s bedside within 15 minutes.
- Follow strict protocols for the treatment of acute stroke, including the use of treatments such as tPa (a powerful yet tricky clot-breaking drug) and/or the transfer of patients who need intra-arterial therapy known as MERCI.
- Employ a medical director with advanced training and commitment to continuing education
- Ensure the 24/7coverage
- Adhere to a 45-minute window from patient arrival to conduct and evaluate a CT scan and laboratory results and to begin treatment.
- Establish and staff a dedicated in-patient unit for continued stroke care.
“Good intentions are not enough in order to receive this kind of designation,” says neurologist Heidi Schwarz, M.D., leader of Highland’s stroke management team. “The fact is, when a community hospital applies for this kind of designation, it is scrutinized more closely than the bigger hospitals. We had to make a convincing case that all the services and capabilities are active and in place in our smaller setting, where the same services might be assumed to be in place elsewhere.”
The stroke team leaders are Dr. Schwarz, Emergency Department Associate Director Mike Cunningham, M.D., and project coordinator Sheri Flynn, R.N. Their primary task was to coordinate and align the many hospital departments and services that are necessary to provide optimum stroke care. Such departments included radiology, emergency, lab medicine, neurology, nursing, and rehabilitation, plus the intensive care unit and an in-patient unit.
“Even though all of these services are located within one facility, it took a concerted effort to align them all to what we wanted to accomplish and what we needed from each,” says Dr. Schwarz, an assistant professor of neurology at the University of Rochester School of Medicine and Dentistry and chair of neurology at Highland Hospital. Dr. Schwarz spends two weeks each year on the stroke service at Strong Memorial Hospital.
In addition to a vision, it takes a hospital’s financial commitment to meet the state’s standard. For example, due to the extreme urgency for evaluating and then properly treating a stroke patient, diagnostic and laboratory equipment must be available at a moment’s notice and properly staffed with the appropriate personnel.
Highland Hospital purchased a second CAT scanner and ensured CT technician coverage 24 hours a day. Additional centrifuge equipment was purchased for the laboratory in order to ensure quick evaluation of a stroke patient’s blood. Heart monitoring equipment known as telemetry was purchased and installed in a dedicated in-patient stroke unit.
In addition, the entire emergency department, inpatient & Intensive Care Unit physican’s assistants and nurses have been trained for stoke care and protocols because they are our emergency response team members.
A dedicated and secure telephone line in the emergency department, “which enables ambulance crews to call ahead with specific patient information yet ensure patient privacy in compliance with HPPA privacy regulations,” says Dr. Cunningham. “In addition, we have developed an efficient protocol for all stroke patients in the ED.”
Not all hospital units are the same; many are dedicated to a specific level and category of care, and stroke is no exception. “On West 7, we pursued extensive nurse training in telemetry and other nursing-specific needs for optimum stroke care,” says project coordinator Flynn.
Community Involvement: Time = Brain
Time equals brain; the less time it takes to treat a stroke, the less brain (and function) is lost. “We seek to improve the recognition of stroke symptoms by the general public and to faster response by our emergency services personnel,” says Dr. Cunningham, who has worked with emergency personnel on first-response recognition and treatment. “I can’t emphasize enough how important it is for all of us – the general public, emergency personnel, and hospital personnel – to act quickly.”
Warning Signs of Stroke
With acknowledgement to the American Stroke Association, we remind everyone of the warning signs of stroke:
- Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause
Not all of these warning signs occur in every stroke. If some occur, don’t wait. Get help immediately. Stroke is a medical emergency. Call 911.