24 Hours on the Job at the RMH Stroke Care Program
I receive an alert on my iPhone: “Brain Attack ED – ETA 20 mins.
The brain attack call from Emergency Medical Services means a patient will be arriving to RMH within 20 minutes. I am relieved because this means the person will be quickly seen by our Brain Attack team.
EMS comes through the Emergency Department doors with the patient and our team is waiting. EMS updates us on the time the person was last known to be well and when the onset of symptoms occurred.
As time passes, I track what is happening with the patient. The ED physician and neurologist assess the patient together. The patient gets a CT scan to make sure he is not having a hemorrhagic stroke (bleeding in the brain); lab work is drawn, blood pressure is taken, swallowing screens are being monitored. Some staff members are updating and reassuring the family.
Our team decides that this person is a candidate for tPA - a clot-busting drug. The ED works quickly with the pharmacy and the tPA is delivered. Within the hour, this stroke survivor starts moving his left side. It feels like a miracle!
The next day, we have to do a thorough review of the patient record to put the stroke puzzle together. Questions need to be answered: how much time passed between the onset of symptoms, arrival at the ED, and start of tPA?
The quicker the tPA is given, the better the outcome will be for our stroke survivor. After the patient is admitted, a timeline is created to look at areas of improvement. I might need to make some phone calls or send emails to clarify questions and concerns. After doing the timeline, I assess that our team was able to get the tPA started in 47 minutes from the time he entered the Emergency Department doors. We have met our Target Stroke Goal for this patient! The goal is to get tPA started in 60 minutes or less. By working quickly and efficiently, we have saved the stroke survivor a lot of brain cells. Kudos goes out to the medical team for a job well done!
As the day passes, I review all the admissions at RMH to see if any other patients might be diagnosed with stroke. Red flags include any patient with dizziness, vision problems, weakness, falls, stroke, mini strokes, high blood pressure, loss of brain function, uncoordinated walking, etc. We want to provide evidenced-based care as soon as possible.
Part of my job also consists of brainstorming and planning for community stroke education and networking within the organization. For instance, we want to bring stroke education to our Latino community. I was delighted to discover that there is already a Latino Health Fair in the works! With this big idea already rolling, the RMH stroke program can be part of this great event..
It’s time to call into the Sentara Stroke Coordinator’s conference call. Today we are going to review the Stroke Patient and Family Education booklet page-by-page that we designed. With a background in patient education, I volunteered to help write and design the first draft.
It’s time to meet with the Stroke Work Team. This means presenting current data on Stroke Core Measures, Sentara Comparison, Brain Attack log, customer satisfaction for the month, and making sure everyone is on track. This time is for relaying new ideas and ways to improve our stroke program to the interdisciplinary team. Today, our team is planning a stroke conference and ways to communicate Stroke Awareness Month this May.
I’m at home. My husband asks about my day. Where do I start? I tell him about the great things we do to support our community, and the satisfaction I get every day from the fact that our team is improving the health of our community.
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