Neuro: Wasting No Time
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Success key No. 3: Improving awareness
While healthcare organizations acknowledge that speed is essential in stroke care, some patients may not be aware that they are having a stroke simply because they are unfamiliar with the symptoms. A stroke sufferer may misinterpret a headache or trouble moving a leg, not realizing that the situation is potentially serious.
Because of that lack of knowledge among the general public, some hospitals are committed to increasing education programs for patients. There is much work to do. Long Beach (Calif.) Memorial began offering an array of education programs after it realized that less than 20% of stroke patients seek hospital care quickly after identifying possible symptoms, says Angie West, the stroke care program director for the MemorialCare Neuroscience Institute, part of the MemorialCare Health System, which has 1,549 beds. "Less than 10% get here in the right amount of time to make a difference," West says.
Generally, the AHA and the ASA aim to increase the number of eligible acute ischemic stroke patients who receive IV rtPA in 60 minutes or less, but that hasn't been easy to do. In a review of more than 2 million patient records contained in the organizations' Get with the Guidelines Stroke registry, only 19% to 22% of patients had a "door to needle" time of less than 60 minutes within the past two years.
Long Beach Memorial runs community meetings to spread the message about stroke care. West coordinated one recently for a group of aeronautical engineers in Southern California. The hospital reached out to the group because of the lack of understanding about strokes, she says.
"We work in the community and try to encourage people in the community to know what the signs and symptoms of stroke are," she says. "The problem with stroke or the challenge with stroke is that it doesn't hurt; people ignore it, because you don't have crushing chest pain or symptoms such as slurred speech or heaviness in the arm. People wait and don't act on it, so it's really important to push the community to get here in the hospital for care," she says.
Hospitals are taking different steps to improve educational processes for patients. The 840-licensed-bed Wake Forest Baptist Medical Center in Winston-Salem, N.C., implemented a coaching program that focuses on stroke patients. The coach is often a nurse, but could be another healthcare professional or a social worker, for instance, says Cheryl D. Bushnell, MD, associate professor of neurology and director of Wake Forest Baptist's primary stroke center.
The coaching program has been included in a pilot project that also includes educational screening tools to help identify hospitalized patients who may be at higher risk for a second stroke or are having trouble with their medications or appointments, says Bushnell. The idea is to improve transition from hospital to home and avoid potential rehospitalization, she adds.
Hospital officials get a sense of patients' health literacy, "such as their confidence in filling out medical forms without help," she says. In her study, 93.9% of those in a coaching group knew what to do if there were problems or if their conditions worsened, compared to 77.8% who weren't coached, she adds. Overall, 93.8% of the patients who had been in the coaching group saw their primary care providers after discharge, while only 60% in the control group made such a visit.
"We are assessing the best way for patients to learn new information through the coaching program," she says.
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