PeaceHealth speeds response to benefit those having stroke

Frances Zable knew she was having a stroke.

One minute, she was putting away the vacuum cleaner. The next, she couldn’t see, her right arm was paralyzed against her stomach and she couldn’t move her legs.

Her significant other, Dick Dreese, wasn’t sure what was happening, but he knew he needed to call 911.

“I knew she wasn’t doing good because she couldn’t see and couldn’t move,” Dreese said.

Within minutes, the ambulance was at the couple’s Washougal home. Paramedics loaded Zable, 84, into the ambulance and headed for PeaceHealth Southwest Medical Center.

At the hospital, Zable was whisked through a variety of tests — a CT scan, blood draws, physical evaluations — and given a drug to break apart the blood clot that caused her stroke.

“It just felt like we were going fast all the time,” Zable said.

That speedy treatment is what PeaceHealth Southwest caregivers have been working hard to provide to their stroke patients. By streamlining processes, eliminating unnecessary steps and educating first responders about stroke response, PeaceHealth Southwest’s stroke program has been able to consistently beat the national average for “door-to-needle” time of 60 minutes.

Door-to-needle time refers to the amount of time it takes for a patient who appears at the hospital emergency department to receive one of two treatments for strokes: administration of the intravenous clot-busting medication, tPA, or a surgeon using a catheter to physically remove the clot.

While the hospital’s door-to-needle time wasn’t always more than 60 minutes, the providers felt they could do better, said Dr. Sarice Bassin, director of PeaceHealth’s stroke program.

“The earlier the patient can get tPA, the earlier you can get the blood vessel open, the better for the patient,” she said.

About 1.9 million brain cells die every minute they’re without oxygen, Bassin added.

“Truly, every second counts,” she said.

So, in May, the stroke program formed a multidisciplinary team — involving neurology, neurosurgery, emergency medicine, radiology, pharmacy, access services, laboratory and emergency medical services — to look at each step of the response process.

Typically, when a patient appears at the emergency room with neurological symptoms of a stroke, providers need to quickly make a decision whether the patient can benefit from tPA treatment. The drug must be administered within 4 1/2 hours of the onset of symptoms, Bassin said.

“By the time a patient gets to the hospital, you don’t have a lot of time to work with,” she said.

Once at the hospital, the patient would then be evaluated in the emergency room and taken back for a CT scan of their head to ensure there wasn’t bleeding in the brain, which would signify a different type of stroke, a hemorrhagic stroke, that isn’t treated with tPA. Next, the patient has to have blood drawn and labs run, review medical history and give consent for treatment. Then, the providers order the drug, the pharmacy mixes the drug and, finally, the drug is administered.

“And you try to do all that within 60 minutes of the patient getting to the ER,” Bassin said.

The multidisciplinary team looked at each step and found ways to shave a few minutes from multiple areas and began implementing changes, Bassin said.

For starters, when the emergency department learns a stroke patient is en route, a page goes out to the entire stroke team.

“Everyone is on alert there is a patient who may need treatment in the next 60 minutes,” Bassin said.

Stroke program providers also worked with EMS to ensure responders recognized stroke symptoms and knew to get patients to an emergency department quickly, Bassin said.

When the patient arrives at the hospital, rather than taking the patient from the ambulance bay to an emergency department room, the patient receives a brief evaluation in the hallway — to ensure they’re stable and breathing — and is immediately taken back for a CT scan.

While getting prepped for the scan, the patient is being hooked up to an IV and blood is drawn for labs. The nurse is also in the room getting the patient history, and the neurologist is at the bedside reviewing treatment options.

During the hours that a neurologist isn’t on site, PeaceHealth uses telemedicine to allow the neurologist to have a virtual visit with the patient within minutes, Bassin said.

“A stoke is a brain emergency, so these patients are treated almost like a trauma,” she said.

The drug, which the pharmacy begins preparing after getting the alert from the ER, is then administered to the patient. In some cases, the patient may also head to the cath lab, where a neurosurgeon removes the clot.

“The faster the patient can get an effective, approved treatment for a stroke, the better their neurological outcome,” she said. “The faster the vessel can be opened, the more brain cells are saved.”

While Zable was in the ambulance headed to the hospital, she feared the possible lasting effects of her stroke.

“I just thought I was going to be in a nursing home,” she said.

Instead, she woke up and was able to see and move. She spent a week at PeaceHealth Southwest before moving to a Portland rehabilitation facility, where she stayed for another week.

Two weeks after her stroke, Zable was back home and feeling good. She does still have some numbness in her fingertips on her right hand, her right foot and the right side of her abdomen.

“Every day it gets a little better,” Zable said.

Zable believes Dreese’s quick action and the speedy response from paramedics and hospital staff saved her life.

She has a simple message for people who think they may be experiencing a stroke: “Don’t mess around. Don’t hesitate to go to the hospital.”