1. Stroke Systems of Care A Regional Approach to Optimizing Patient Care and Outcomes

2. Agenda
What and why?
Regional system components
Path forward

3. What is a Stroke System of Care?
A comprehensive, diverse, longitudinal system that addresses all aspects of stroke care in an organized and coordinated manner.
EMS plays a significant role in this system! Training and collaboration are imperative for success
Typically the first medical professionals with direct patient contact
Their initial assessments, actions, treatments and decisions have significant impact on patient’s subsequent care
Their role in patient triage, diversion and routing cannot be under-estimated

4. Why do we need a system?
Systems minimize delays in the chain of survival
Deliver the right patient to the right place in the right amount of time
A coordinated response system for time critical conditions such as stroke and STEMI has shown to prevent mortality up to 10%1
1Source:
2Source: CDC -

5. Why do we need a system?
Why integrate Stroke and STEMI? Arkansas compared to US Average (Age-adjusted death rates per 100,000), 2014
Arkansas
United States
Acute Myocardial Infarction (AMI)
rank #1
(Approx.2500 AMI deaths/year)
32.4
Stroke
rank #5
(Approx Stroke deaths/year)
36.2
Source: Centers for Disease Control and Prevention. CDC Wonder.

6. The Right Patient The Right Place The Right Time The Right Care
Why do we need a system?
The Right Patient
The Right Place
The Right Time
The Right Care

7. The Need for Speed Every second 32,000 brain cells die
Every minute 2 million brain cells die
For every hour, up to 200 million brain cells die and the brain ages 4 years!

8. 9-County Pilot Program (2016-2017)
Compared the pilot data to baseline data (N=222 confirmed stroke patients during August 2015 – July 2016)
Only 49.7% arrived via EMS, rest by private transport or other means.
EMS pre-notification of a suspected stroke increased from 38% to 69.2%
Time to treatment (IV t-PA by 2 hours, and treat by 3 hours) improved by 21%.
EMS pre-notification was nearly doubled in the pilot study and was associated with improved Door to t-PA time compared to private transports (p=0.026).

9. Regional Systems of Care
Ensure that all stroke patients are rapidly identified, transported, or transferred in a timely fashion to a hospital that provides the most appropriate level of care for the particular clinical situation
(1) Ensure effective collaboration
(2) Promote standardized approach
(3) Identify performance measures
(4) Identify potential Issues/Barriers
Southwest – 1st Region

10. Components of SW Regional Approach
Community Education
According to the American Heart Association and the American Stroke Association, 50 percent of people drive themselves or have someone drive them to the hospital when heart attack and stroke symptoms are present. Nationally and locally, the average time from arrival to treatment is significantly reduced by EMS.

11. Components of SW Regional Approach
EMS
Pre-hospital stroke screen
Pre-hospital notification
Blood glucose check
Stroke banding
Last known well time documentation
Minimum patient care guidelines
Hand-off form to ED

13. Hand Off / EMS Short Form

14. Components of SW Regional Approach
Hospitals
Tiered Levels of Stroke Care
Comprehensive Stroke Center (CSC)
Dedicated neuro ICU with 24/7 staffing
Catheter angio 24/7
Able to meet concurrent needs of multiple complex stroke patients
24/7 neurointerventionalist, neurosurgeon, neurologists
Aneurysm clipping/coiling, carotid stenting, endovascular care
Primary Stroke Center (PSC)
Additional capabilities vs. ArSRHs
Stroke unit or designated beds
Neurosurgical available within 2 hours
Arkansas Stroke Ready Hospital (ArSRH)
Standards similar to The Joint Commission Acute Stroke Ready
24/7 ED coverage
Dedicated stroke coordinator
Availability of standardized acute ischemic stroke protocol
Transfer and transport protocol in place
24/7 physician availability – either on-site neurologist or telestroke coverage
24/7 CT and 27/7 laboratory availability
Participate in AR Stroke Registry

15. AR Stroke Ready Hospitals

16. Components of SW Regional Approach
Data Collection and Performance Improvement
EMS Data Registry
Arkansas Stroke Registry
Future Linkage Projects

17. Components of SW Regional Approach
Continuing Provider Education
EMS, physicians and nurses
In-person such as Advanced Stroke Life Support
Online Education such as APEX stroke module
Quality Assurance Webinars

18. Path Forward
Opening Stroke Designation Statewide – If not yet applied, go to ADH website and completed application to Dr. Tammie Marshall and David Vrudny
Stroke Registry Participation – If not yet participating in AR Stroke Registry, contact David Vrudny for details on possible grant support to cover cost of Get With The Guidelines-Stroke Patient Management Tool license

19. AR Time Critical Diagnosis System
Trauma
Trauma
Stroke
Community
EMS
Hospitals
STEMI
Questions?