If the measure of a clinical program’s impact is its size, the Stroke Program at University of Colorado Hospital doesn’t have a lofty rank. Two-thirds of the core team – four members – fit relatively comfortably in a Leprino Building office on a recent morning.
But if the measure of impact is service to patients, families, providers and the community, the Stroke Program packs a punch. In the past year, the team has, among other efforts, spearheaded efforts to increase knowledge about and recognition of stroke and its symptoms; worked with providers in the hospital and community to ensure rapid response to stroke victims; helped to ensure stroke patients and families get integrated care from admission to discharge to follow-up; and committed to strengthening connections between the hospital and the communities it serves.
Of course, all the work ultimately saved time, brain and lives. The efforts drew national attention last week with the announcement that the Stroke Program was one of seven groups and individuals to earn a RAISE (Raising Awareness in Stroke Excellence) Award from the National Stroke Association (NSA). The team earned the award in the “Outstanding Group” category.
“The award means we’ve spent a lot of time growing the program for both the community and for our hospital staff,” said Meredith Snyder, RN, manager of the Stroke Program.
Teamwork and beyond
But Snyder and her team (see box), which came together last February, are quick to point out that they are part of a much larger, ongoing effort to provide superior stroke care. As evidenced by consecutive Joint Commission certifications of the hospital as a Comprehensive Stroke Center, in 2013 and 2015, that’s been accomplished, even through various leadership changes that began three years ago.
Hospitals with the certification – there are just three in Colorado – are capable of handling the most complex stroke cases and providing integrated care, from admission through discharge and follow-up. That requires multidisciplinary care and collaboration between a host of clinical providers, encompassing emergency services, neurology, radiology, clinical lab, pharmacy, nursing, critical care, rehabilitation services, volunteer services, and more.
“That foundation laid the groundwork for what we are doing today,” said Tonie Schoenleber, RN, one of the Stroke Program’s three clinical coordinators. Schoenleber focuses on ensuring providers and staff get essential stroke education, such as using the National Institutes of Health Stroke Scale to assess patients for signs and severity of stroke and neurologic changes. Schoenleber also works with clinical coordinator colleague Kerri Jeppson, RN, to push training and education to the inpatient units’ “Stroke Champions,” who in turn deliver the information to nurses and staff to ensure they are ready to respond as quickly as possible to Stroke Alerts.
The numbers underscore the importance of keeping skills sharp and awareness high. The hospital responded to a total of 317 ischemic strokes and transient ischemic strokes (TIAs) from Jan. 1 to Sept. 30, 2016, up from 250 for the same period in 2015, said Tovah Adler, RN, also a clinical coordinator with the Stroke Program. The numbers of patients receiving intravenous clot-busting tPA on admission to the Neuro ICU and those sent to UCH from other facilities or from UCHealth’s Mobile Stroke Treatment Unit after receiving tPA also grew significantly during the same period.
Reach out, we’ll be there
Adler credited the increases in part to outreach to emergency services providers by the Stroke Program and University of Colorado School of Medicine physicians through monthly talks and advanced life support training. The effort has been bolstered by the hospital’s EMS manager, Floyd Salazar, Snyder added.
“EMS outreach is a huge part of what we do,” she said. “We have worked on getting out to the community and letting them know what we do here and that that we appreciate what they do.”
Part of that effort includes informing EMS techs of the hospital’s interventional radiology treatment capabilities and its nationally recognized Neuro ICU – reasons for them to bring a stroke patient to UCH for life- and limb-saving care.
UCHealth’s burgeoning telestroke program, coordinated by Christy Denton, RN, MSN, provides another important bridge to the community. The program, launched in 2014, allows neurologists at UCHealth to conduct remote consultations with providers at other hospitals and assess patients for signs of stroke.
A variety of other initiatives aim to bring stroke care and information to patients and caregivers inside and outside the hospital.
“Patient education and community outreach are the drivers of what we do,” said Angela Vasilatos, specialty clinical programs coordinator for the Stroke Program. She noted that the team rounds on stroke patients and their families to bring familiar faces to the bedside and to monitor their care through follow-up clinic visits that should occur within seven days of discharge.
The outreach work also includes a support group that Vasilatos said currently draws 10 patients per session. There’s also SSTARS (Stroke Survivors Taking Aim at Recovery), a volunteer group of six that helps stroke patients in the hospital prepare to move to the next level of care. The Lifelong Education and Advocacy Program (LEAP), which the hospital launched in conjunction with the NSA in 2009 to provide ongoing help for stroke survivors and caregivers, drew 50 attendees at its spring session, Vasilatos added.
“When we treat someone with stroke and see them come back full circle through the LEAP Program, we feel like we’ve put the right pieces together,” Snyder said.
The program receives strong support from physicians, including co-medical directors Sharon Poisson, MD, and Robert Neumann, MD, PhD, and William Jones, MD, PhD, medical director for the Mobile Stroke Treatment Unit at UCH. Poisson, for example, went on camera to explain the symptoms of stroke to 9News viewers at September’s Health and Wellness Expo, sponsored by UCHealth and the Denver Broncos. Luis Cava, MD, a Neuro ICU physician, spoke about stroke risk and prevention to several hundred Latinas at Vestido Rojo, a national American Heart Association-sponsored event.
The Stroke Program lives by the mantra that “time is brain,” and continues to fine-tune the processes and technology that speed neuron-saving treatment to patients. Its “Target: Stroke Elite Plus” award from the American Stroke Association is one tangible example of the program’s success in getting tPA to a large majority of ischemic stroke patients in 60 minutes or less.
Just as valuable as those data points are comments from the patients whom the program’s providers and the hospital helped to survive their ordeals.
“I was treated so well by the entire team… the stroke team, all the nurses, therapy, and techs,” one said to Schoenleber. “Thank you all for making a difference in this man’s experience here in the hospital.” Said another of the LEAP Program, “This seminar was great at answering questions I didn’t even know I had.”
Snyder sees such comments as confirmation of the entire organization’s success in building bridges to stroke patients.
“My main goal is to have the Stroke Program recognized in the community and in the hospital and for people to know how much all of our staff and providers have been integral to the process,” Snyder said.
Six for stroke
Core members of the UCH Stroke Program team:
- Meredith Snyder, manager
- Tovah Adler, clinical coordinator
- Kerri Jeppson, clinical coordinator
- Tonie Schoenleber, clinical coordinator
- Christina Denton, telestroke coordinator
- Angela Vasilatos, specialty clinical programs coordinator