What is a stroke?  The two main types of stroke include ischemic stroke and hemorrhagic stroke.  Ischemic stroke occurs when a blood clot forms that blocks blood flow to part of the brain.  A hemorrhagic stroke occurs when a blood vessel on the brain's surface or in the brain ruptures and fills the surrounding areas with blood.  Without blood and the oxygen it carries, brain cells start to die.  Brain damage can begin within minutes.  It is important to know the symptoms of stroke and act fast as quick treatment can help limit damage to the brain and increase the chance of a full recovery.

 

 

 

Over 1200 patients each year are admitted to Baystate Health (BH) facilities for evaluation and treatment of ischemic stroke.  Multidisciplinary management and coordination are key factors that help patients return to their optimal function.  Successful treatment begins with early and rapid identification of the etiology of the stroke, administration of thrombolytics if appropriate, prevention of acute complications, and formulation of a rehabilitation plan, and concludes with an appropriate treatment plan aimed at preventing recurrent stroke.

 

Each of the three BH hospitals is a designated Primary Stroke Center (PSC) by the Department of Public Heath for the Commonwealth of Massachusetts, as well as an active participant in the Stroke Register and the Stroke Collaborative Reaching for Excellence (SCORE) Project.  The PSC designation is built on the premise that stroke teams can effectively and efficiently care for the stroke population.  SCORE is a quality improvement collaborative that supports Primary Stroke Service-designated (PSS) hospitals in Massachusetts which is funded by the Centers for Disease Control (CDC).  BH stroke teams review the care provided for opportunities or gaps on which to focus their efforts.  Interventions include localizing and implementing standardized clinical practice guidelines from evidence-based recommendations and measuring progress against statewide/national benchmarks.  The teams continuously monitor process and outcome quality indicators which include hospital-acquired complications, mortality, length of stay, antithrombotic at discharge, lipid measurement and treatment, and smoking cessation counseling.  Emphasis has been on screening and administering t-PA for acute ischemic stroke, consistent assessment of the patient using the National Institutes of Health (NIH) Stroke Scale, DVT prophylaxis, bedside swallowing evaluation, use of antithrombotic therapy within the first 24 hours and at discharge, and early rehabilitation consultation. t-PA is a “clot-busting” medication which can restore or greatly reduce neurological impairment if given within appropriate time parameters.

 

Highlights

 

Baystate Health Ambulance 

• Standardized neurological assessments, such as a tPA eligibility screen and Stroke Scale, are performed to facilitate early identification and notification to the emergency department.
• Notable increase was observed in the timely transport of patients who may be potential tPA candidates.

 

Baystate Medical Center 

• BMC has worked in partnership with the Centers for Disease Control (CDC) as a Coverdell hospital from 2002 and now participates in the SCORE Project to determine the feasibility, usefulness, and spread of a national stroke registry. 
• This partnership served as a testing ground and helped to drive the national focus on improving stroke care.  BMC was initially designated as a PSC in December 2004 and was re-designated in 2010.
• In 2011 BMC received American Heart Association/American Stroke Association Gold-Plus Performance Achievement Award and SCORE Defect Free Care Award for reliably providing evidence-based recommendations and treatments to patients with stroke. 
• Currently, the use of antithrombotic drugs at discharge (e.g., aspirin, clopidogrel and warfarin) is 100%; better than the Mass Coverdell benchmark.
• Smoking cessation counseling is 100%; better than the Mass Coverdell benchmark.
• DVT prophylaxis within 24 hours is 89%; lower than the Mass Coverdell benchmark.
• Early antithrombotic is 99%; consistent with the Mass Coverdell benchmark.
• Stroke mortality has decreased overall since we began our initiative, and currently is slightly less than expected.
• Ongoing analysis of stroke-related mortality reveals no adverse patterns or trends.
• The BMC Neurologists continue to provide Telemedicine services to BFMC & BMLH.  Telemedicine was implemented in the BMC ED in 2011 and is completely operational.
• Due to the lack of neurosurgical coverage in some of the rural hospitals in the region, BMC has entered into agreements with Berkshire Medical Center, North Adams Hospital and Fairview Hospital to accept neurosurgical patients in transfer.

 

Baystate Mary Lane Hospital 

• BMLH received initial PSC designation in late 2005, and was re-designated with “no deficits” in stroke care in December 2009. 
• BMLH is an active participant in the SCORE Project.
• The BMLH Stroke Focus Group and the larger multidisciplinary Stroke Committee meet quarterly to review data and improve systems and processes.
• The use of Telemedicine to determine the appropriate plan of care has been a key component of rapid identification and treatment of patients potentially eligible to receive tPA. 
• Currently, a goal for the ED is to begin early treatment (aspirin, treatment for hypertension, high cholesterol, and DVT prophylaxis) for all patients presenting with stroke symptoms.
• Performance feedback is given regularly to clinical personnel involved in caring for the stroke patient.
• BMLH received American Heart Association/American Stroke Association "Silver Achievement Award" for reliably providing evidence-based recommendations and treatments to patients with stroke. 

 

Baystate Franklin Medical Center 

• Designated as a Primary Stroke Service by Massachusetts Department of Public Health.
• In April 2011, BFMC received the Massachusetts Department of Public Health Stroke Collaborative SCORE defect-free care award.
• In April 2011, BFMC was the recipient of the American Heart Association/American Stroke Association's "Get with the Guidelines Gold Plus Award" for reliably providing evidence-based treatment for patients with stroke.
• In June 2011, BMFC was the recipient of the "Most Outstanding Innovative Program Paper" award for "Listening to Newborns: What Babies Have to Say About Transitions to Life," presented at the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) General Assembly.

 

For more information on Quality at Baystate Health

For more information on Baystate Medical Center

For more information on Baystate Mary Lane Hospital

For more information on Baystate Franklin Medical Center

For more information on Baystate Health Ambulance

For more information on Stroke Massachusetts or American Stroke Association

For more information on the American Heart Association

For more information on the Centers for Disease Control