Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 29,710 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Monday, October 22, 2018
9 issues stroke systems of care must address to improve outcomes
But you still don't know how fast clots need to be removed to get 100% recovery, so you are still shooting in the dark. Nothing on stopping the neuronal cascade of death, so you are not adequately informed on what needs to be done to solve stroke.
EMS triage and
destination, emergency department, transfer and stroke team protocols
are essential to rapid definitive treatment for ischemic stroke
Oct 16, 2018
A system of care
is a collection of processes that interact to identify and treat a
patient with a specific medical condition. Ideally, a system of care is
explicitly designed so that the various processes interact in ways that
make it more likely for patients to have better clinical outcomes.
Without
an explicit effort by the many different agencies and institutions
involved to work together at a systems level, systems of care usually
evolve haphazardly over time through a series of policy and procedure
decisions. These decisions are commonly made at the individual agency
and institution level without consideration of the overall system and
its impact on patients.
These non-systemic, but well intentioned,
policies and procedures may help the individual organization or improve
the performance of a particular process they manage. Unfortunately,
these actions may have a net negative impact on the patient. That is
because a key principle in systems design is that that the performance
of a system is not the sum of the performance of each of its parts –
it’s a product of their interactions.
Stroke is one of
the high-risk time-sensitive conditions that benefits from a systems
of care approach. (Photo/Allied Academies)
Acute ischemic stroke systems of care
Stroke
is one of the high-risk time-sensitive conditions (HIRTSC; pronounced
“hurt-see”) that benefits from a systems of care approach. Like other
HIRTSC, clinical outcomes for stroke are improved when definitive care
is initiated as soon as possible. This is the reasoning behind the
phrase “time is brain” when caring for the acute stroke patient. There
are two general categories of stroke – ischemic and hemorrhagic. This
article will focus on the system of care for acute ischemic strokes
(AIS).
Definitive care for AIS is removal of the clot that is
blocking flow in the affected arterial vessel(s) in the brain. This is
accomplished with either thrombolytic drugs, mechanical thrombectomy or
both (if they can be initiated within certain time limits).
Therefore,
a stroke system of care should consist of processes that will minimize
the acute onset to definitive treatment time interval. Based on the
timing and circumstances, the stroke system of care should identify
which patients are best suited for thrombolysis versus thrombectomy and
direct patients accordingly to the most appropriate hospital.
To
accomplish the goals of rapid definitive treatment and long-term
favorable outcomes, the stroke system of care should address the
following nine issues across the entire community/region,
not just for a specific 911 communications center, ambulance service,
rescue agency, hospital, rehabilitation center or physician practice:
Public education. The general public will need
processes to encourage and help them to quickly and reliably identify
stroke symptoms, and convey the urgency in accessing emergency care –
preferably via EMS so that field triage and care can direct patients to
the most appropriate hospital and manage any complications prior to
hospital arrival.
911 communications. Dispatch should identify
potential stroke cases so that appropriate pre-arrival instructions can
be conveyed. They can also inform responding EMS units of a possible
stroke case so crews have an increased awareness of the possibility in their assessment.
Due to the time sensitivity of stroke, EMS unit selection for
deployment to the scene decisions should consider the closest available
unit, regardless of jurisdictional boundaries. If mobile stroke units
are available, the 911 communications center may play a role in
dispatching or pre-alerting them based on the dispatch center’s clinical
impression.
EMS triage and destination protocols.
Non-transport medical first response and ambulance crews will need
protocols to guide the triage of likely stroke cases and discern which
cases are likely large vessel obstruction
cases. Based on parameters for time elapsed since “last known well” and
differences in travel time between facilities with and without LVO
capabilities, the protocols should inform the selection of a destination hospital.
EMS crews should also have protocols for making formal declarations of a
stroke alert with early notification of the destination hospital so
preparations can be made in advance of patient arrival.
Emergency department protocols. Emergency
departments should have protocols in place to quickly screen for stroke
cases on walk-in cases and immediately prioritize their care. They
should also have processes for how to respond to EMS stroke alerts
with preparation for CT scanning and stroke team activation. These
protocols may include “direct to CT” policies for patients who meet
specified criteria.
Inter-facility transfer protocols. If the initial
destination hospital ED does not have mechanical thrombectomy
capabilities or if the patient will require more advanced care due to
comorbidities or other complicating factors, process will be needed to
promptly request and prepare the patient for an emergency inter-facility
transfer (a Stat transfer). The ambulance service that provided the
scene-to-hospital transport, the ground or air ambulance service that
provides the actual interfacility transport and the receiving hospital
will all require protocols for these cases.
Stroke team protocols. Processes are needed to
quickly notify the stroke team when a stroke alert is declared.
Different versions of the protocols may be needed for when the stroke
team members are already in the hospitals versus after hours scenarios.
Post-acute care. Processes are needed to ensure a
smooth transfer from acute to post-acute care. In cases involving
severe disability or complications, this may involve transfer to long
term acute care and/or skilled nursing facility care. Even with low
severity cases, there should be referral to and completion of a stroke
rehabilitation program.
Secondary prevention. Processes are needed to
refer stroke patients back to their primary care physicians and any
specialists for follow-up to begin processes for secondary prevention
and support their compliance.
Systems level QA/QI and research. Throughout this
continuum, for an acute ischemic stroke episode of care, there should be
processes in place to gather data that is abstracted into registries or
similar tools. This data should measure the performance of the various
processes outlined and give prompt feedback on a case-by case level to
clinicians (and on an aggregate level for organizational and systems
level feedback). This abstracted data can then help identify improvement
opportunities and research. Participation in formal clinical registries
at a state/national level is preferred as the large numbers of cases
can support registry-based research. Agencies and institutions that
participate in the community/regional system of care for stroke should
regularly meet as a group to review systems level performance reports
and collaborate in systems-level improvement and research projects.
A community/regional stroke system of care consists of many
different organizations, teams and functions within those organizations,
hand-offs, communications needs – and opportunities to do each part
well and connect it to the next part of the system of care well (or not
so well). That’s why the design, operation and improvement of our stroke
systems of care needs to address the whole system of care.
About the author
Mic Gunderson is the president of the Center for Systems Improvement – a consulting firm specializing in design and value improvement for high-risk time-sensitive care.
His prior positions include national director for clinical systems at
the American Heart Association; EMS system director for Kent County EMS
in Grand Rapids, Mich.; president at Integral Performance Solutions;
national director for quality, education and research with the
Rural/Metro Corporation; director of research and education with the
Office of the Medical Director in the Pinellas County, Fla., EMS system.
Over the course of his career, he served as a field EMT, paramedic
and firefighter, clinical manager and director with military, private
and governmental EMS agencies. Mic has authored and edited a wide range
of articles and textbooks, and has served on the boards of directors for
several national EMS organizations.
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