Neuro: Wasting No Time
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This article appears in the November 2012 issue of HealthLeaders magazine.
Before neurologist Andrei Alexandrov, MD, joined the 1,146-bed University of Alabama at Birmingham Hospital more than five years ago, the hospital had an uncertain vision for a comprehensive stroke program, which was more piecemeal than programmatic; the hospital addressed only certain aspects of stroke care. Then Alexandrov and his colleagues drew up a planning document approved by the C-suite that proposed dramatic changes in neurology care that would cascade through the system. This vision encompassed new multidisciplinary teams, revamped hiring practices, new clinical approaches, and innovative research.
Since then, the hospital has developed a proven comprehensive care program, and gave it a name that befits its purpose: The Comprehensive Stroke Research Center has a team of neurologists and nurse specialists who cover a wide swath of specialties, including a neurological urgent care center, and a memory disorders clinic for a variety of neurological conditions such as Alzheimer's, Parkinson's, and other diseases that affect the brain.
As one of dozens of hospitals dubbed a center of excellence by various organizations, the University of Alabama at Birmingham Hospital has tripled the number of patients enrolled in its neurological programs the past five years and is now at approximately 1,000 stroke patients per year. In addition, 60% of ischemic acute admissions are treated in less than two hours from symptom onset. Treatment should be carried out within three hours of onset, according to American Hospital Association guidelines.
What Alabama has done demonstrates the approach to neurological care geared to excellence that is changing the landscape for neurological patients, especially those in need of stroke care. "To organize such a program you need an institutional commitment for change. That's No. 1," Alexandrov explains. "Years ago, the traditional practice of stroke care meant you reacted to a problem and did the bare minimum. Diagnose. You give the patient some aspirin. But the idea of a comprehensive stroke center or a neuroscience center of excellence is that the buck stops here, for care. If a patient needs the most sophisticated procedure or complex care, that's where the patient should go."
Hospitals are finding a path to excellence in different ways. Successful programs are specializing in stroke care, offering advanced procedures, building a case for a primary care stroke center, and taking on strategic opportunities by coordinating programs with other hospitals that have limited programs.
Lacking resources, some hospitals rely on connections with more advanced hospitals that obtained the primary stroke center certification for expanded stroke care delivery for patients. Stroke care is a complicated series of procedures and different specialties, especially focused on what has become a healthcare mantra in dealing with strokes: "Time lost is brain lost."
Most strokes are ischemic, caused by lack of blood flow in the brain usually due to a blockage or blood clot. The window for treatment to reverse the damage from an ischemic stroke is measured in hours. One minute of brain ischemia can kill 2 million nerve cells and 14 billion synapses, thus reducing the odds of a good outcome as time elapses before intravenous thrombolysis, according to the American Heart Association and the American Stroke Association.
Echoing many healthcare leaders, Angie West, RN, MSN, CNRN, CCRN, director of neuroscience/stroke for MemorialCare Neuroscience Institute, part of the MemorialCare Health System, in Long Beach, Calif., says, "Time is brain. The longer patients wait, the more brain cells die, and [patients] have less-functional outcomes. Time is of the essence."
The hospital achieved the AHA's Get with the Guidelines Stroke Gold Plus Performance Award, which showed that it achieved 85% or higher adherence to guidelines for two or more consecutive 12-month intervals and compliance with quality measures.
Timeliness is reflected in the overall target of bringing a patient to be treated within 90 minutes of an attack. Without such attention, a patient can face complications related to other damaging and costly issues, such as readmissions within 30 days. A campaign created by the AHA and American Stroke Association—Target: Stroke—is designed to help hospital teams achieve door-to-needle treatment delivery times of 60 minutes or less for ischemic stroke patients who receive thrombolytic therapy. This prompt care is accomplished by providing evidence-based strategies, clinical decision support, measurement tools, and other resources.
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