Stroke is the third leading cause of death in the United States and the leading cause of disability. Prompt diagnosis and treatment is key to saving lives and reducing permanent disability. In June, Delaware County Memorial Hospital (DCMH) joined an elite group of hospitals that deliver expert stroke care by becoming a Certified Primary Stroke Center by The Joint Commission. There are approximately 400 hospitals in the United States that have earned this designation.

“Stroke center certification signifies that the hospital has met higher standards for evaluation and treatment of acute stroke patients as defined by The Joint Commission,” explains Joseph Lubeck, D.O., chief of the Section of Neurology at DCMH, where in 2007, 275 patients were treated for stroke or transient ischemic attacks.

“There is an urgent need for improvement in diagnosing, treating and rehabilitating patients who suffer a stroke,” notes Maureen DePrince, stroke coordinator for DCMH.  “The stroke initiative is consistent with the mission of the Crozer-Keystone Health System, which is to continually improve the care of our patients and to provide appropriate services.”

Certification Ensures Consistency and Excellence

Certification is based on guidelines developed by the American Heart Association and the American Stroke Association. They require applicants to have a stroke team and neurosurgical services available around the clock, written diagnosis and care protocols, close coordination between the emergency department and emergency transport, and a dedicated stroke unit, in addition to specific clinical expectations. 

Earning certification requires optimal performance from everyone involved in transporting, evaluating and treating a stroke patient. Four months of treatment data is submitted during the application process. DCMH was the first Crozer-Keystone hospital to apply for stroke certification.

“Starting a stroke program takes a lot of hard work and can only be done with the support of hospital leadership and the entire multidisciplinary team,” DePrince says. “Our entire staff has risen to the occasion, and is doing an excellent job implementing new protocols and guidelines.”

“I think of stroke treatment as having four phases: the acute treatment, the hospitalization in which the goal is to minimize complications, the rehabilitation and the prevention of recurrent strokes,” Lubeck says. “We still lack a miracle cure for stroke, but [having certification] means that patients have a better chance for a favorable outcome in the acute phase and a lower risk of complications. We are also ensuring that patients are started on treatment and educated on lifestyle modification to reduce their chance of another stroke.”

Timing is Key

Time is critical in treating strokes, which are often caused by blood clots in arteries leading to the brain. For example, t-PA, an agent to dissolve clots, is most effective when administered within three hours of the onset of stroke symptoms. This means that patients have to reach the hospital and be evaluated within that window. Dissolving clots quickly can prevent the loss of brain tissue – and permanent disability – due to lack of oxygen. 

However, t-PA and similar drugs carry major risks as well, the greatest of which is bleeding in the brain, which can cause more damage. The bleeding risk of clot-dissolving drugs increases with time and, after about three hours, exceeds their limited benefit. 

The three-hour window of opportunity for treatment begins when symptoms begin, so patients must recognize what is happening, seek care, be evaluated and receive treatment within that period. That’s why it is critical for people experiencing paralysis, confusion, numbness, dizziness or other potential stroke symptoms to get to a hospital quickly. Ideally, that hospital would be certified in stroke evaluation and treatment.

What Patients Can Expect

At DCMH, “an acute stroke patient can expect to be rapidly triaged and evaluated by members of our stroke team,” DePrince says. “We will determine their eligibility for thombolytic therapy [t-PA] and follow protocols for care, treatment and rehabilitation. We also focus on secondary prevention, education specific to patients’ needs, to prevent a recurring stroke. We identify risk factors and work with patients on modification through medication and lifestyle.”

Primary stroke centers are required to diagnose possible stroke patients quickly. At DCMH, CT scans and lab work are completed and evaluated within 45 minutes of patients’ arrival in the emergency department. From transport to diagnosis to treatment, this deadline demands peak performance from every group involved. 

As systems within DCMH have been streamlined to deliver excellent care efficiently, a simultaneous effort has begun to educate the public about the signs of stroke. 

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In Brief

• In May 2009, Taylor Hospital became certified as a Primary Stroke Center. There are slightly more than 500 hospitals across the nation that have earned this designation. 
• Certified Primary Stroke Centers meet the highest national standards of care for stroke and adheres to guidelines that can significantly improve outcomes for stroke patients.
• Taylor joins Delaware County Memorial Hospital and Crozer-Chester Medical Center as the only Certified Primary Stroke Centers in Delaware County.
• The difference between hospitals that are Primary Stroke Centers and those who are not is that Stroke Centers have processes in place for rapid diagnostic testing (CT scan and laboratory) and can determine if the patient is eligible to receive tPA, a clot-busting drug.
• Stroke is a medical emergency. The longer a person waits for treatment, the more brain cells die permanently. Know the symptoms of stroke and call 911 if you suspect someone is having a stroke.