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Wisconsin Coverdell Stroke Program

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Wisconsin Coverdell Stroke Program

  1. 1. Paramedic System of Wisconsin Tundra Lodge September 18-20, 2013 Dot Bluma, RN QI Stroke Specialist MetaStar, Inc. www.metastar.com Cathy Etter, BSN, CCEMT-P EMS QI Consult
  2. 2. Objectives • • • • • Appreciate the importance of a partnership between EMS and hospital providers Recognize the time-sensitive nature for treatment of an acute ischemic stroke patient Describe challenges and successful strategies in meeting prehospital stroke care Describe the recommended components of an appropriate pre-hospital assessment of a potential stroke patient Understand the recommendations of the American Stroke Association and Coverdell Stroke Program for pre-hospital providers
  3. 3. Statistics • • • • • Stroke is the 4th leading cause of death in the United States Stroke is the leading cause of long-term disability More than 795,000 people have a stroke each year in the United States Total annual stroke costs to the nation are about $38.6 billion Transport by EMS of stroke patients to the hospital results in faster treatment, yet one-third of stroke patients do not call 911 to use EMS to get to the hospital Source: CDC State Heart Disease and Stroke Prevention Programs. Retrieved from http://www.cdc.gov/dhdsp/programs/stroke_registry.htm
  4. 4. Target Stroke American Heart/American Stroke Associations •Best Strategy Practices inception in early 2010 •Target Stroke Goal: At least 50 percent of patients receive IV tPA in 60 minutes or less → “The Golden Hour” Target Stroke. Retrieved from http://www.strokeassociation.org/STROKEORG/Professionals/TargetStroke/TargetStroke_UCM_314495_SubHomePage.jsp
  5. 5. Coverdell Objectives Right Care at the Right Time Coverdell focuses on the continuum of patient care: •Support development of stroke systems of care •Eliminate disparities in care •Decrease rate of premature death and disability •Measure, track, and improve the quality of stroke care
  6. 6. Coverdell Goals for Wisconsin • • • • Develop statewide Stroke Systems of Care Build a hospital stroke registry Support hospital education and quality improvement Support EMS education and quality improvement
  7. 7. Acute Stroke Care “Time is Brain” •Timing and a fast response are critical •A stroke is a brain attack where time lost is brain lost! •During an ischemic event the average person loses 32,000 brain cells per second! The most important piece of information is an accurate last known well/normal time! Jauch et al, 2013. Stroke. Early Management of Acute Ischemic Stroke; 44:870-947.
  8. 8. Emergency Room Care Treatments •IV tPA within 3 hours; up to 4.5 hours for certain eligible patients •Endovascular procedures in carefully selected patients – – IA tPA Mechanical Devices Jauch et al, 2013. Stroke. Early Management of Acute Ischemic Stroke; 44:870-947.
  9. 9. Mode of Arrival to Hospital Q1 & Q2 2013 This Get With The Guidelines® (GWTG) Aggregate Data report was generated using the Outcome™ PMT® system. Copy or distribution of the GWTG Aggregate Data is prohibited without the prior written consent of the American Heart Association and Outcome Sciences, Inc. (Outcome).
  10. 10. Emergency Room Care Emergency Room Care of the Acute Stroke Patient Team Based Approach • • • • • • ER Physician ED RN Stroke Team Radiology Department Lab Neurologist • • • • Radiologist Pharmacy Neurosurgeon Physician Extenders (NP, PA) • Interventional Radiology Team
  11. 11. Emergency Room Best Practice Strategies • • • • • • Door to physician ≤ 10 minutes Door to stroke team ≤ 15 minutes Door to CT initiation ≤ 25 minutes Door to CT interpretation ≤ 45 minutes Door to drug ≤ 60 minutes Door to stroke unit admission ≤ 3 hours Jauch et al, 2013. Stroke. Early Management of Acute Ischemic Stroke; 44:870-947 .
  12. 12. ED Arrival 2 hours from LKW Q1 & Q2 2013 This Get With The Guidelines® (GWTG) Aggregate Data report was generated using the Outcome™ PMT® system. Copy or distribution of the GWTG Aggregate Data is prohibited without the prior written consent of the American Heart Association and Outcome Sciences, Inc. (Outcome).
  13. 13. ED Arrival 3 hours from LKW Q1 & Q2 2013 This Get With The Guidelines® (GWTG) Aggregate Data report was generated using the Outcome™ PMT® system. Copy or distribution of the GWTG Aggregate Data is prohibited without the prior written consent of the American Heart Association and Outcome Sciences, Inc. (Outcome).
  14. 14. ED Arrival 2 hours from LKW Q1 & Q2 2013 Pre-notification This Get With The Guidelines® (GWTG) Aggregate Data report was generated using the Outcome™ PMT® system. Copy or distribution of the GWTG Aggregate Data is prohibited without the prior written consent of the American Heart Association and Outcome Sciences, Inc. (Outcome).
  15. 15. Stroke EMS Best Practice Strategies • EMS Pre-notification – Priority Dispatch • Stroke Tools – Protocols, Guidelines, Stroke Scales • Rapid Triage Protocol – < 10 minute scene time – Blood Glucose monitoring – Blood Pressure measurement
  16. 16. Stroke EMS Best Practice Strategies • Single Call Activation – Activate Stroke Team • Transfer Directly to CT – Depends on patients stability – Airway management Target Stroke. Retrieved from http://www.strokeassociation.org/STROKEORG/Professionals/TargetStroke/TargetStroke_UCM_314495_SubHomePage.jsp
  17. 17. On Scene Care • Pre-Hospital Stroke Scale ─ Cincinnati or FAST ─ Face ─ Arm ─ Speech • Last Known Normal/Well Time ─ Wake up impaired? • Contact Name and Phone Number ─ Who saw them last? Target Stroke. Retrieved from http://www.strokeassociation.org/STROKEORG/Professionals/TargetStroke/TargetStroke_UCM_314495_SubHomePage.jsp
  18. 18. EMS Report to ED • Signs/Symptoms of Stroke – Pre-Hospital Stroke Scale Results • ETA – Early notification is vital • IV 18g – Do NOT delay transport • Additional Complaints/Information
  19. 19. EMS Report to ED • Last Known Normal/Well Time • Medications – Anticoagulants are important • Vital Signs – Blood Pressure – Blood Glucose • Repeat ETA Target Stroke. Retrieved from http://www.strokeassociation.org/STROKEORG/Professionals/TargetStroke/TargetStroke_UCM_314495_SubHomePage.jsp
  20. 20. EMS Goals  Less than 10 minute scene time  Pre-Hospital Stroke Scale Reported  Blood Glucose checked  Blood Pressure measurement reported  Early ED notification  Direct to CT whenever possible
  21. 21. Hospitals & EMS: Improving Stroke Care • Develop Quality Improvement Committee – Routine Quality Improvement review – Partner to share patient outcomes, review cases, and data – Timely feedback from ED – Review with all staff involved – Address any delays in transport – Discovery of learning opportunities • Member recognition for a job well done • Continuing Education in stroke care – Mock stroke codes Target Stroke. Retrieved from http://www.strokeassociation.org/STROKEORG/Professionals/TargetStroke/TargetStroke_UCM_314495_SubHomePage.jsp
  22. 22. The Big Picture Link the care of the stroke patient between EMS providers and stroke-ready hospitals by identifying evidence-based, best practices through collaboration, education, and advocacy to improve patient outcomes.
  23. 23. Questions?
  24. 24. Thank You!

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