Time is brain. That simple but critical equation—knowing that approximately 2 million brain cells die every minute during a stroke—has driven 442-bed Mary Washington Hospital in implementing its successful drive to become a Joint Commission-certified Primary Stroke Center during the past 1½ years.
The Fredericksburg, Va.-based hospital purchased the American Heart Association and American Stroke Association's evidence-based Get With the Guidelines program and trained all 300 emergency room staff on stroke, the third-leading cause of death and leading cause of adult disability in the U.S.
“We took out any delays in care,” says Eleanor Redmond, stroke team coordinator. “It's very important that we work together as a finely tuned team. … We were able to look at how we were practicing our stroke care, from the time the patient was put into an ambulance to the time we discharged them.”
Read about the honorable mention in the quality categoryTo focus on administering the clot-busting drug IV tPA Activase, Mary Washington worked to eliminate any and all process delays through its “Code Neuro” protocol. The hospital has been able to make critical laboratory results available within two minutes and CT scan results within 45 minutes; the tPA utilization rate is now 11%, well above the national average of 2% to 3%. For these results, Mary Washington has earned the 2009 Spirit of Excellence Award for Quality.
“We have hospitals calling us now,” says Redmond, who believes the establishment of her position to put one person in charge of the process is a critically important step. “We have an obligation to network with other hospitals. … There's a huge disparity in how stroke patients are treated, depending on whether they're primary stroke centers.”
Mary Washington also implemented a screening for dysphagia to reduce aspiration in stroke patients. “Stroke patients have a high risk of food and liquid going into their lungs,” says speech pathologist Rebecca McClelland. “We have a very short test that nurses can administer, with a little applesauce and a little water.”
Quality category judge Tiffany Coury, associate administrator at Manatee Memorial Hospital, Bradenton, Fla., whose organization received the Spirit Award for Quality Honorable Mention last year for implementing a similar program, says the subject is “near and dear to my heart.”
“The mission of developing a stroke program is one that is purely driven by wanting to provide quality patient care,” Coury says. “I commend this hospital and all hospitals that spend the resources and time to put these programs in place because the community truly benefits."
