And just why the fuck should we go to a 'care' center rather than a 'results' center? If you can't tell us your results you are hiding how fucking bad you are. We have to completely change how stroke is discussed, every single article on stroke should be mentioning exactly what the failures are and what is being done to fix them. Notice they don't tell us;
tPA full recovery better than 12%?
Full stroke recovery better than 10%?
30 day stroke deaths better than your competitors?
Hospital wins Primary Stroke Center status; East Georgia Regional Medical Center, Statesboro,GA
After a year of refining and monitoring its stroke care processes and with the addition of a tele-stroke program, East Georgia Regional Medical Center recently won certification as a Primary Stroke Center by The Joint Commission and the American Stroke Association.
Primary Stroke Center status indicates that the Statesboro hospital provides rapid, consistent primary stroke treatment, meeting Joint Commission and America Stroke Association standards, said EGRMC Stroke Program Coordinator Bryan Realiza.
“It means that we have put forth the time, energy, resources and funding to create a set of processes here at our facility that should happen every time a stroke patient comes into our hospital,” Realiza said. “So in terms of efficiency and reductions in variation of care, this is what we want to see for our community.”
Stroke-prone area
The hospital serves Bulloch County and some neighboring counties which have higher rates of strokes and stroke deaths than Georgia overall.
In fact, a Centers for Disease Control and Prevention online report ranks Bulloch eighth among Georgia’s 159 counties in hospitalizations of Medicare beneficiaries over age 65 for strokes. The rate in Bulloch, from 2015-17, was 15.8 stroke hospitalizations per 1,000 Medicare beneficiaries, compared to 12.4 statewide and 11.6 stroke hospitalizations per 1,000 Medicare beneficiaries nationally.
“We’re the eighth-highest county in stroke hospitalizations in Georgia, which is a big deal,” Realiza said. “A lot of stroke patients are coming here, and prior to this, there were no strict guidelines on what we should do. So there was probably a little bit more variation until we came in and said, no, this is what we want to do every single time.”
Like many hospitals across the country, East Georgia Regional Medical Center also maintains its general accreditation through The Joint Commission. In the collaborative stroke center certification program, the Joint Commission awards its trademarked Gold Seal of Approval while the America Stroke Association, or ASA, awards a Heart-Check mark.
A number of the standards require meeting time limits in diagnosis and treatment. For example, a head CT scan, blood work and an electrocardiogram are all supposed to be done within 45 minutes of a patient arriving with stroke symptoms.
‘Time is brain’
“Making sure that things happen quickly” is important because “with a stroke, there’s a common saying that ‘Time is brain,’” Realiza said.
In other words, without treatment, more brain tissue can die with the passage of time, leading to permanent disability or even death. So EGRMC is now committed to making sure that these standards of timeliness are met.
The hospital had to monitor these and other goals and standards for four months to even request a Primary Stroke Center evaluation, but ended up monitoring for a full year. This was partly because the evaluation process was delayed by the COVID-19 pandemic.
Realiza created flow charts of the hospital’s newly standardized processes for evaluation and treatment of strokes. He said he strived to make these easy to understand so that they can be given to new EGRMC employees, such as nurses, and provide them quick guidance on what is expected.
The ASA and Joint Commission surveyor who visited the hospital complimented him on accomplishing that, Realiza said.
After visiting EGRMC Nov. 13, the surveyor reported back to the certification board, and the hospital administration was notified of the certification Nov. 29.
“We congratulate East Georgia Regional Medical Center for this outstanding achievement,” American Stroke Association CEO Nancy Brown said in a media release. “This certification reflects its commitment to providing the highest quality of care for stroke patients.”
Realiza said the required standards were the same for East Georgia as they would be for a Mayo Clinic or the Cleveland Clinic. However, he also noted that what EGRMC has achieved is Primary Stroke Center certification. A hospital with more resources could be certified as Comprehensive Stroke Center.
“A Comprehensive Stroke Center means you have a neurosurgeon on site that can intervene surgically if a stroke is happening,” Realiza said. “Now, we don’t have any neurosurgeons here at our hospital. So what we do is we try to stabilize them with medicine.”
In particular, a medication called Alteplase, which some people know as TPA, can sometimes be given as an infusion to stop a stroke.
However, a number of contraindications can prevent Alteplase from being administered. Additionally, some other conditions can mimic a stroke, and Alteplase has to be given within four and a half hours after symptoms appear.
Tele-stroke
Evaluating whether a patient is actually having a stroke and can benefit from Alteplase or will need surgery at another facility is where EGRMC’s tele-stroke program helps, Realiza said.
The hospital launched this program in January, contracting with the multispecialty telemedicine group Access Physicians to provide a 24-hour, seven-days-a-week connection to neurologists specializing in stroke treatment.
“We needed a neurologist to really be there quickly to make that call, and so that’s what our tele-neurology, tele-stroke program does,” he said. “We are able to get a neurologist in front of that patient in 15 minutes to make the call.”
That 15-minute target is not one of the standards for a Primary Stroke Center but was the hospital’s own goal.
Each tele-stroke cart carries a very high-resolution digital camera that the neurologist can use to look closely at a patient’s eyes and check the reactivity of the pupils. A nurse at bedside positions a microphone-backed stethoscope for the neurologist to listen to heartbeat and blood flows.
Three neurologists in Texas, Florida and Michigan provide the Access Physicians tele-stroke services, appearing on screen.
Local neurologists
But two Statesboro-based neurologists, Dr. Kashyap Patel and Dr. Michael Taormina, are affiliated with EGRMC and provide in-person, day-to-day care.
“With our stroke patients, both our tele-neurologists and our local neurologists work together as a group,” Realiza said. “What happens is, the tele-neurologists take on the front end, getting there quickly, identifying what’s going on, and once they’ve decided that patient is able to stay here in our facility, they’ll pass the baton to our local neurologists … and they’ll do the follow-up care.”
Realiza is not a doctor himself but holds master’s degrees in healthcare administration and business administration and serves as the hospital’s stroke program coordinator and chest pain program coordinator. Before the stroke center certification work, he guided the effort that resulted in East Georgia’s accreditation as a Chest Pain Center by the American College of Cardiology in August 2019.
Support and education
He also launched a stroke support group for patients and family caregivers at the beginning of 2020. Only two monthly meetings were held before COVID-19 halted the project. Realiza and EGRMC Marketing Director Erin Spillman said they hope the group will be able to hold quarterly meetings in 2021.
They also hope to bring more community education programs, such as those for awareness of stroke symptoms, to events such as health fairs, when COVID-19 relents. Incidentally, stroke was the fifth leading cause of death in the United States, in CDC reports, before the coronavirus moved ahead of some of the usual top causes.
Role of EMS
In his statement about the stroke center certification, the hospital’s CEO, Stephen Pennington, thanked area Emergency Medical Service agencies for working with EGRMC in improving stroke response.
“Our
relationship with local EMS encourages the use of field assessment tools
and communication prior to transporting patients with stroke-like
symptoms to our Emergency Department,” Pennington said. “As a Primary
Stroke Center, this joint effort allows the best possible outcome for
all patients.” (But that outcome must not be good because you tell us no factual statistics on recovery.)
