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Hospital committed to stroke care excellence by Cindy Abole Public Relations The results of a stroke can affect people in different ways. For some, a stroke can be fatal.      Modern medicine has improved the success of stroke care by introducing new medications and therapies that can often help patients survive a stroke if treated promptly using the right therapies.   At MUSC, providing high quality stroke care and the availability of certain stroke therapies for patients has made MUSC a premiere stroke treatment facility in the state. Last fall, hospital leaders organized a stroke program certification steering committee composed of emergency medicine physicians, nurse managers, neurologists, neuroradiologists, staff nurses, rehabilitative specialists from physical and occupational therapy, dietary, speech pathology and other practitioners to outline the Medical Center’s focus on stroke care priorities.      Neurointensivist Julio Chalela, M.D., and outcomes manager Lisa Langdale, R.N., were the catalysts who brought the team together and helped focus the hospital towards stroke certification. Chalela is fellowship-trained in both vascular neurology and neurocritical care.   A result of this multidisciplinary group’s progress was the hiring of new Stroke Program nurse coordinator Chris Zensen, R.N., in May. A West Virginia native, Zensen is a critical care and trauma nurse who has worked at MUSC in the STNICU since 1998.      To help create an effective stroke care program and demonstrate the hospital’s commitment to stroke care excellence, the center began to seek certification as a Primary Stroke Center with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). A formal application will be submitted this fall to certify they have met requirements and a site visit will be scheduled.  Once the  center has achieved JCAHO certification, the Medical Center will also receive a Gold Seal of Approval that distinguishes MUSC from other statewide hospitals as the Palmetto state’s leader in acute stroke care.   Every 45 seconds, someone in the United States suffers from a stroke. Nationally, stroke is the leading cause of death behind heart disease and cancer. It is the third cause of death in South Carolina. The state leads the nation in strokes and is located in what’s considered the country’s stroke belt; a region in the Southeast whose states, Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia, have a higher stroke incidence and mortality compared to the rest of the country. To add fuel to the fire, the Lowcountry is considered the “belt buckle.” Berkeley, Dorchester and Charleston are reported to have more combined stroke incidents than the entire state combined. Establishing stroke center certification   The BAT includes from right Dr. Feng Liu, MD Neurology resident; Dr. Ashtok Patel, Neurology; Dr. Julio Chalela, Neurology and attending physician; Chris Zensen, stroke program coordinator; third-year College of Medicine students Jonathan Osorio, Moncia Kim and Zach Stroud. Call 792-3333 and ask for the BAT. To earn certification as a Primary Stroke Center, MUSC must comply with some of the most rigid national standards and guidelines available for stroke care. Other prerequisites included the establishment of the Brain Attack Team (BAT), a 24/7 rapid-response stroke treatment team that consists of an attending physician, neurologists, radiologists, emergency medicine physicians, neurology and neurosurgery residents, pharmacists, nurses, and other stroke care experts.   “It takes a team of experienced, knowledgeable people who are supportive and dedicated to a shared vision of stroke care excellence,” Zensen said.   In addition to staffing, Zensen also will create and establish programs to help ensure patients are treated using stroke program guidelines from the American Heart Association, American Stroke Association and American Association of Neurology. Zensen will also maintain a stroke patient database that will evaluate quality of care and adherence to guidelines, and she will also create patient education and prevention programs to reduce stroke reoccurrence.      After almost three months on the job, Zensen and the stroke certification committee have accomplished a lot. In late May, she introduced the BAT service to staff and began teaching them about stroke basics, including the differences between two common types of stroke: ischemic (clotting) or hemorrhagic (bleeding). Ischemic stroke, the most common type, occurs when there is an interruption of blood flow to the brain. A third type of stroke, transient ischemic attacks, is characterized as mini warning strokes that indicate a blockage to the brain’s blood flow that often heralds an ischemic stroke.      “In the time she’s held this position, Chris has accomplished a remarkable amount of groundwork and made great strides working with faculty, physicians, team members, patients and their families,” said Sharon DeGrace, R.N., director of Critical Care Services and Emergency Medicine. “Therapeutic Services director June Darby and I began working together to hire a stroke program coordinator to augment work already begun by Dr. Chalela and Lisa Langdale. It’s remarkable at how everyone has pulled together to help it succeed. I couldn’t be more proud of all the disciplines committed and involved in this effort of successful collaboration.” BAT in action The BAT responds to all adult inpatient locations throughout the hospital, including the Transitional Care Unit and Institute of Psychiatry. They also will respond to adult outpatients transported to the emergency department and Meducare transport patients from areas around campus. Hospital staff may call 792-3333 and ask for the BAT.   In stroke care, lost time equals lost brain. The team is trained to respond within 15 minutes to a stroke call.   Once the team arrives, they will work with the patient’s nurse in conducting an immediate assessment and help stabilize the patient. Like a coach pushing her team, Zensen’s role during a BAT response is to evaluate the situation and steer staff in doing what needs to be done to ensure that everything runs efficiently to protocol. A team member will perform an NIH Stroke Scale, physical exam and collect patient history and data. Once the patient is assessed, another member will notify the admitting service of the BAT activation, arrange for labs, a CT scan and other urgent interventions.   “This is an important opportunity for MUSC to make improvements in the way we provide stroke care. We need to do things better and we owe it to the people of South Carolina to do just that,” said Chalela, assistant professor in the Department of Neurosciences and the team’s attending physician. He hopes to someday expand these services to a full-time unit entirely devoted to inpatient stroke care.   Once a patient is assessed for stroke, the team quickly decides the appropriate treatment regimen for that patient. In recent years, use of the clot-busting drug, Tissue Plasminagin Activator (tPA), has achieved remarkable results for qualified stroke patients. The drug must be given within three hours of  stroke symptom onset. Another treatment gaining interest among practitioners is the administration of tPA with a catheter to the groin to help break up a blood clot. The procedure, known as an intra-arterialthrombolysis, must be conducted within eight hours of stroke onset and is performed by MUSC interventional neuroradiologist John Deveikis, M.D. MUSC is the only hospital in the state that can offer this highly specialized procedure to stroke patients. Promoting stroke care      When she’s not responding to the BAT “signal,” Zensen is meeting and talking to stroke patients, families, case managers, nurses and staff regarding care, recovery or rehabilitation. She’s also reviewing information from resources like the American Stroke Association and Brain Attack Coalition to ensure compliance to stroke patient protocol. Her biggest challenge today is identifying new stroke patients who have been admitted to the hospital for one condition and have suffered from a stroke while in the hospital. She is working with a newly created stroke database using a medical record number, hospital location or name to help her locate and follow patients admitted for specific conditions.      “It’s exciting to see patients improve and get better with time or see their own family participate in their care,” Zensen said. “It tells us that they’re getting the tools and other support they need in their care and recovery.”      She also refers any problems to the stroke steering committee for guidance and resolution. Always a nurse and advocate, Zensen and the stroke committee are concerned with gaining ground on improving the Lowcountry’s stroke numbers. Even as she prepared herself to interview for this position, she was surprised to read about the problems with stroke incidence in the Palmetto state. Today, she’s more convinced that the Lowcountry’s high stroke occurrence may stem from multiple issues that are genealogical, geographical and educational in scope.     “We need to step up to the plate and learn the facts about stroke in order to educate people who may be at risk,” Zensen said, citing numerous hospital studies that compare the advantages of primary stroke certified centers and improved patient outcomes. “But first and foremost, we need to provide better stroke care for patients. Our patients are always number one with us. To help them achieve optimum health, we need to be certified as a primary stroke center.”   Once the program gains ground, Zensen would like to work closely with emergency medical service personnel in Charleston, Berkeley, Dorchester and Colleton counties to continue training teams in stroke education, treatment guidelines and other practice programs.   Finally, Zensen revealed further plans to collaborate with other successful community education programs across campus like the Stroke Initiative of South Carolina and the College of Nursing’s Reach 2010. Both are programs designed to assist and work with high- risk patient populations to learn healthy methods to control hypertension and make healthy choices as they relate to stroke care and prevention. Stroke Warning Signs Loss of sensation; weakness (especially one-sided); confusion; trouble speaking or understanding; dizziness; loss of coordination; loss of balance and trouble walking; and sudden, severe headaches Stroke Certification Steering Committee Dr. Julio A Chalela (chairman), Effie Amerson, Diane Andrews, Natalie Ankney, Farooq Bandlai, Ann Benton, Mary Bierman, Dr. Alice Boylan, Wendy Bullington, Dr. Christine Carr, Dr. Patrick Cawley, Stephanie Chomos, Tracy Conner, June Darby, Sharon DeGrace, Dr. John Deveikis, Brian Fletcher, Sally Jarvis, Julie Jones, Lisa Langdale, Marc LaPointe, Rebekah McCowen, Mary Price, Mansle Raines, Dr. Larry Raney, Karina Rojas, Erica Rouvalis, Ellen Ruja, Dr. Zoran Rumbold, Ramona Smith, Elizabeth Thomas, Paige Thomas, Cat Walters, Tracy Weaver and Chris Zensen     Friday, Aug. 25, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.