COOS BAY — Bay Area Hospital has received the Stroke Bronze Quality Achievement Award for the first time after making changes in how stroke patients are treated in the Emergency Department.
“The Bronze Award is awarded for consecutive days of appropriate medication regiment, which is interesting because the project we worked on was initial assessment,” said Heather Thoma, RN and Chest Pain Center Coordinator at BAH. “The other spectrum of stroke care is their discharge medications and medication they received in the hospital. We met compliance on seven separate quality achievements for 90 days in a row.”
The award is through the American Heart Association and the American Stroke Association’s Get With the Guidelines program.
These changes included implementing new processes such as a dysphasia screening, or a swallow test.
“When someone has a stroke, it can harm their swallow ability,” said Dr. Michael van Duren, Chief Medical Officer at BAH. “If we don’t test that before giving them food or medication, it can choke them or give them pneumonia.”
Now the hospital is at 90 percent in the last quarter for implementing the dysphasia test.
BAH has also improved the nurse workflow by making changes to the documentation. Chief Quality Officer Kelli Dion explained that the checklist staff go through when a stroke patient comes in is what was changed, putting the form up front for care givers to see so there is no hunting for it.
“In quality improvements, there is plan, do, check, and act,” van Duren said. “You try one thing like changing the checklist, to putting it on the board on the wall in the Emergency Department. Multiple cycles of making this small change make the difference until you find what works.”
BAH has also directed its attention to the education provided to stroke patients that focuses on risk factors, warning signs and when to call 911.
According to Thoma, the hospital sees potential stroke patients daily and anywhere between 20 to 30 actual stroke patients a month.
When the call comes in overhead that a stroke patient is coming into the Emergency Department, van Duren compared medical response in the hospital to a MASH unit.
“Whoever is in the CT machine is taken out so it’s freed up,” he said. “We have the clot dissolving medication ready. ‘Time is brain,’ as they say.”
The longer a patient goes without being treated after a stroke has happened, the more damage can happen to the brain. Thoma pointed out that the hospital likes to get medication administered to a stroke patient within the first 50 minutes. In that time beforehand, the patient is triaged, a doctor sees them, and a CT scan is done to be sure the problem isn’t something else that could be worsened by stroke medication. Once the results are back, medication is administered.
“The patient’s outcome depends heavily on when they present for care,” van Duren said. “If they are at home hoping for symptoms to go away impacts the short time period we can give that medication. It’s important for them to come in right away so we have time to treat them.”
In addition, patients are advised to call 911 for an ambulance to the hospital rather than being driven because an ambulance is faster, and, like van Duren said, “Time is brain.”