Each year, about 700,000 new or recurrent strokes occur in the United States, killing about 150,000 people. That's one stroke every 45 seconds, and one stroke death every three to four minutes. About 15 percent of strokes occur within 90 days of a transient ischemic attack (TIA)—a warning sign of impending stroke. And the incidence of TIA exceeds that of stroke.
So improving treatment and outcomes for stroke patients is critical to the health of our communities. And St. Luke’s Magic Valley is making impressive strides in this area.
In December of 2011, a team of physicians, nurses, nursing leadership, and administrators met to assess the care and needs of stroke patients in the region. Last fall, they decided St. Luke’s Magic Valley was ready to pursue certification as a primary stroke center. Dr. Matthew Larsen and Stephanie Shawver, R.N., were named to head up the effort as medical director and program coordinator.
“There is a crucial need for advanced stoke care across the country,” Dr. Larsen said. “With technology and treatment advancements, the need for early and aggressive care of stroke patients is essential to ensure the best possible outcome for this devastating condition.”
The team called on national experts and Sarah Walker, R.N., and Dr. Jim Torres, experts within the St Luke’s Health System who led the recent stroke certification of St. Luke’s in the Treasure Valley. They began by studying the stroke patient population. Who are these stroke patients? What need can be identified immediately?
In the year prior to the focused effort on stroke care, it was observed that only 20 percent of stroke patients presented for care in the three-hour time frame needed for delivery of aggressive treatment.
This indicated that community education was essential. Team members fanned out, participating in community events, filming local news segments, and continuing to broaden their community education tactics.
Based on these efforts, the percentage of patients presenting in the three-hour time frame has increased to 30 percent.
The next step was determining how best to standardize care and create protocols to match best practices as defined by the American Stroke Association and Brain Attack Coalition.
Although St. Luke’s Magic Valley has a five-star rating from Healthgrades when it comes to in-hospital mortality of stroke patients, the team recognized the need to streamline processes across the continuum of care, from emergency medical services all the way through rehabilitation.
Implementing best practice protocols and addressing all aspects of stroke care has resulted in improved care. This year, the team has seen its best time for presentation of patient to administration of clot-busting medication: 47 minutes, well below the national benchmark of 60 minutes.
It’s making a remarkable difference in the lives of our patients, their families, and our communities. Here’s what we heard from a St. Luke’s employee at another site regarding care her family experienced with the Magic Valley team:
“Two days ago, my parents had to take my grandmother to the ED in Magic Valley. They suspected that she was having a stroke. They were in the car driving her home after having Sunday lunch with her when she had sudden onset of confusion, inability to form sentences and garbled speech.
“They were a short distance from the hospital so they drove her to the ED. My parents raved that the care she received was outstanding, from the moment they walked in the door and stated that they thought she might be having a stroke. My mom said, ‘We couldn’t believe how fast help arrived. A team of people met us at her room and her care was immediate!’ My dad in a separate conversation said, ‘Wow, your people were amazing!!’
“… I am constantly looking at opportunities for improvement … I truly know that we provide exceptional care at St. Luke’s, but it is especially great to hear that exceptional care was provided to someone that I care for deeply ...”
“What we are seeing, in such remarkable improvements in our care of stroke patients, speaks to the responsiveness and eagerness of our staff to provide high-quality care for these patients,” Shawver said.
And the recently accredited Gwen Neilson Anderson Rehabilitation Center (GNARC), a 14-bed acute inpatient rehabilitation center that provides state-of-the-art, evidenced-based rehabilitation in a comfortable, home-like environment, allows St. Luke’s Magic Valley to offer advanced rehabilitation services close to home for stroke patients.
During fiscal 2012, the center served 43 patients who had experienced a stroke. More than 73 percent of stroke patients who received rehabilitation at the center were able to return home, compared with 68 percent of such patients nationally. On average, stroke patients were able to achieve functional outcomes above national average.
Magic Valley’s work on stroke is helping St. Luke’s achieve the Triple Aim by improving care and reducing morbidity and mortality, but they’re not done yet. The Stroke Team plans to apply for Primary Stroke Certification this year.
Learn more about St. Luke's stroke care.
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.