Last week, the Missouri Department of Health and Senior Services announced that Mercy Hospital Washington is now a designated Level II Stroke Center. The designation means the state has verified that the hospital’s providers have the expertise and resources required to treat all stroke patients, except those requiring neurosurgery.
For stroke victims, receiving the right level of care within minutes, or within what’s often referred to as the “golden hour,” can make the difference between life and death or between a full recovery and disability. For residents of Franklin and its neighboring counties, having a designated Level II Stroke Center in Washington is an incredible asset.
“For most stroke patients, we’re not only the closest hospital, we’re also the right choice in terms of getting them the care they need as quickly as possible,” explained Joan Frost, chief operating officer at Mercy Hospital Washington.
The Level II Stroke Center designation is part of the state’s Time Critical Diagnosis (TCD) system, a new statewide emergency care model that aims to improve both the speed and quality of care to stroke patients. The system coordinates the 911 response system, ambulance services and hospitals in a comprehensive, integrated approach. All with the goal of ensuring more stroke patients survive, and that they have better recoveries.
Participation in the new system is voluntary for hospitals. To receive the Level II designation, Mercy Hospital Washington went through a rigorous certification process including a two-day on-site review. As part of that review, the hospital had to demonstrate not only that it has the providers and resources needed to treat stroke patients, but that its physicians and staff have met strict standards of education and could demonstrate proficiency in the latest and most proven stroke treatments.
The hospital has a dedicated “stroke team,” comprised of physicians, nurses, CAT scan technicians and lab techs that all work to ensure suspected stroke victims receive rapid and efficient assessment and treatment. One of the group’s primary goals is to minimize the “door-to-needle” time to provide acute stroke patients with tPA, the blood clot dissolving medication that can dramatically improve stroke patient outcomes. Nationally, only 25 percent of patients receive tPA within 60 minutes of arrival to the hospital. At Mercy Hospital Washington, 40 percent of patients are treated within this golden hour.
“Unfortunately, many stroke victims wait too long to call 911, and by the time they get to an emergency department, a lot of time has gone by since they first started experiencing symptoms,” said Bryan Menges, DO, Mercy Hospital Washington’s stroke program director. “That’s unfortunately out of our control. But what we can do is make sure we’re ready to go when they do get to us. That’s one of the reasons we do well above the national average on door-to-needle time.”
To ensure no time is wasted once potential stroke victims call 911 or arrive at the emergency department, Mercy works closely with EMS crews, who notify the hospital that they’re bringing in a suspected stroke patient. That notification activates the hospital’s stroke team, which is then ready to begin assessment and treatment the moment the patient arrives.
As proof that such coordination and preparation is effective, 99 percent of suspected stroke patients arriving or brought in to Mercy Hospital Washington’s emergency department were evaluated by a physician within ten minutes. Ten minutes is the standard set forth by the state. Mercy Hospital Washington’s success at meeting that standard contributed to it receiving the Level II Stroke Center designation.
To-date, Missouri has designated only 23 hospitals as Level II Stroke Centers. Only ten hospitals in the state are designated as Level I Stroke Centers. In general, Level I Centers function as resource centers within a region, for example maintaining specialized resources for the most complex patients.
“People often think a community our size wouldn’t have the capability to treat stroke patients so effectively,” added Frost. “One of the reasons we can do so is that Mercy invested in not only the people we need, but also in a technology that made all the difference. A couple of years ago, we adopted a Telestroke program here in Washington. That program gives us capabilities most hospitals our size just don’t have.”
Mercy’s Telestroke program uses high-tech, powerful computers, cameras, microphones and other technologies to connect virtually to top neurologists from other locations. Those neurologists can see, hear and speak directly with patients, as well as collaborate with the physicians and nurses at the patients’ bedside. Together, the neurologists and the local care team examine, diagnose and suggest the best course of action for suspected stroke patients.
“To have 24/7 access to a board-certified neurologist, effectively at the patient’s bedside, gives our doctors and care team the added expertise we want whenever we’re working to diagnose a stroke,” added Menges.
Last year, Mercy Hospital Washington treated 193 stroke patients. In an effort to further improve stroke outcomes in the community, the hospital routinely sends stroke experts to health fairs and other local events to talk about the symptoms of a stroke and the importance of getting suspected stroke patients to the emergency department as soon as possible.
“We have a fantastic group of physicians, nurse practitioners and other co-workers who have taken on the mission of educating people about the symptoms of a stroke,” added Frost. “They eagerly do radio interviews, staff health fair booths or talk at seminars. They know that for the hospital to do its job, people need to know to call 911 if they suspect a stroke. Our team knows we can do so much more if people get to us quickly.”
Mercy, like most health organizations across the country, tries to get people to remember the acronym “F.A.S.S.T” when they suspect they’re witnessing a stroke. F.A.S.S.T. is an easy way to remember the warning signs of a stroke:
• Face – Ask the person to smile. Does the person’s face look uneven?
• Arm – Ask the person to raise both arms. Does one arm drift down?
• Speech – Ask the person to repeat a simple phrase. Does that person’s speech sound strange?
• Sight – Did the person have a sudden loss of vision?
• Time – Don’t waste time. Act fast and call 911.
Anyone experiencing these symptoms, or who witness these symptoms in another person, should call 9-1-1 immediately. To learn more about your risk of stroke and how to minimize it, ask your primary care physician.