Submitted by Emerson Hospital
Emerson Hospital has received a prestigious award for achieving an impressive standard of care for individuals who arrive at the hospital with stroke. The “Get With the Guidelines” Stroke Silver Plus Award is presented to hospitals that achieve 85 percent or higher adherence, for one year, to 10 rigorous quality standards as defined by the American Heart Association (AHA) and American Stroke Association (ASA). Emerson Hospital achieved that level of adherence for 2012.
In recent years, improving care for individuals who suffer a stroke has become an important public health initiative, driven in part by the proven effectiveness of tissue-plasminogen activator (t-PA), medication often referred to as a “clot-buster.” If given within three hours of the onset of stroke symptoms, t-PA can resolve the stroke and limit neurologic injury. The term “brain attack” increasingly is used to convey that a stroke is as much an emergency as a heart attack.
Joseph Donovan, 76, of Carlisle experienced a brain attack in April. When his wife, Anna, realized his speech was slurred, and he could not lift his left arm, she dialed 911. “If it was a stroke, I knew we had to get to the hospital right away,” Mrs. Donovan said.
At Emerson, a CT scan was quickly performed, which established that Mr. Donovan’s stroke was caused by a blood clot. He received t-PA about two hours, 20 minutes after his symptoms began.
“Joe had received only half the dose of t-PA when he picked up his left arm, which he hadn’t been able to move, and his speech slowly returned to normal,” recalled Mrs. Donovan. “It was just mind-blowing. As a result, his recovery was about weakness, not paralysis.”
“They acted fast,” Mr. Donovan said of the team in Emerson’s Emergency Department. “I’ll be forever grateful.”
Massachusetts hospitals that meet defined standards – such as having experienced staff, rapid testing (including head CT), neurologists who are quickly available, appropriate technology and efficient communication with emergency medical services (EMS) personnel – are designated as Primary Stroke Services (PSS) centers and become a destination for emergency stroke care. Emerson was designated as a primary stroke center in 2005; since then, hospital staff have focused on achieving consistent adherence to the “Get With the Guidelines” measures.
“Administering t-PA, when appropriate, is a key measure because we know it can reverse a stroke,” said Gert Walter, MD, an emergency medicine physician and co-chair of Emerson’s Stroke Committee, which formed when the Massachusetts Primary Stroke Services program began. “We have 24-hour CT scanning capability for that reason. If the patient isn’t a candidate for t-PA, we do everything we can for them. Community residents are fortunate that, in Massachusetts, local hospitals can treat stroke.”
Other measures include the appropriate administration of medications, such as those that prevent the formation of blood clots, thin the blood or lower cholesterol. Nursing staff must screen stroke patients for dysphagia—the inability to swallow—which can lead to pneumonia and other complications. In addition, staff must document that the patient received smoking cessation counseling, if appropriate, and stroke education and was considered for rehabilitation.
“We were all pleasantly surprised to receive the award,” said George Gonzalez, MD, a neurologist and committee co-chair. “I believe that increased awareness of the 10 stroke measures among hospital staff, especially the hospitalists, made the difference, as did use of our electronic medical record, which supports the stroke protocol.” Dr. Gonzalez cites the arrival in 2012 of dedicated stroke coordinator Deborah Benvenuto, RN, MBA as an important addition to the team.
Along with receiving the “Get With the Guidelines” Stroke Silver Plus Award, Emerson was cited for achieving at least 12 consecutive months of 75 percent or higher compliance with five of eight stroke quality measures, which are designed to improve quality of patient care and outcomes.
Emerson Hospital is a multi-site health system headquartered in Concord, Mass., with additional facilities in Sudbury, Groton and Westford. The 179-bed hospital provides advanced medical services to more than 300,000 individuals in 25 towns. To learn more, visit www.emersonhospital.org.
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