Improvements in stroke care already evident

June 21, 2000

Dallas, TX, June 21, 2000 -- A group of more than 75 hospitals across the nation have made substantial progress in improving stoke treatment, already acting on many of the recommendations of the Brain Attack Coalition published in this week's issue of The Journal of the American Medical Association.

The hospitals, participating in the Clinical Advantage program of the VHA hospital alliance, have shown a marked decrease in the time needed to accurately diagnose stroke patients based on CT scans. This significant improvement is enabling emergency room staff to more effectively administer clot-busting tPA treatment to eligible patients within the critical three-hour window from the time the stroke took place.

These results are due to an intensive focus on a number of processes used to evaluate and treat stroke patients, which include:"Timing and proper administration of tPA can mean the difference between life and death, recovery and disability. Through training of existing personnel -- neurologists, EMS staff, attending physicians, nurses, paramedics -- to rapidly respond as an integrated team in these potential situations, these hospitals are already achieving impressive results," said Marilyn Rymer, M.D., national chairperson of VHA's Clinical Advantage stroke initiative and medical director of the Stroke Center for Saint Luke's Hospital in Kansas City.

In the VHA initiative, participating hospitals have reduced the time it took from patients' arrival at the hospital to the interpretation of the CT scan from an average of 219 minutes to 115 minutes, a reduction of nearly 50 percent. Several hospitals -- including MedCentral Health System in Mansfield, Ohio; Fort Sanders Regional Medical Center/Covenant Health in Knoxville, Tenn.; and Union Regional Medical Center in Monroe, NC -- have reported getting their door-to-CT time down to an hour or less.

At Union Regional, the average time from door-to-CT is down to 35 minutes. Emergency room physician Dr. John Hartness, the hospital's stroke team champion, said the program has strengthened the hospital's work processes and protocols for dealing with stroke cases. For example, the hospital has been more aggressive in involving EMS and uses overhead pages for all staff involved. The key, he said, is preparation and organization. Clinicians at the 160-bed rural hospital have administered tPA 15 times since the program began in late 1999, a utilization well above the national average of 2-3 percent of stroke patients.

"It's evident that by focusing on what we know is most effective in treating stroke, and putting in place the processes to act on that evidence, hospitals can make dramatic improvements in patient care," said Stuart Baker, M.D., VHA executive vice president. "As reflected in the JAMA article, health care organizations can and should make these improvements, and I'm pleased we have a growing number of VHA member hospitals making this commitment."

Through VHA's Clinical Advantage, interdisciplinary teams at hospitals across the nation apply evidence-based methodologies, measurement tools and clinical information to improve patient care. The program is organized around specific medical conditions and a framework of resources to accelerate implementation, produce results and overcome barriers to change.

Currently more than 350 organizations and thousands of clinicians are participating in other Clinical Advantage initiatives to improve the treatment of breast cancer and heart attacks, and to reduce medication errors. Efforts to address congestive heart failure, patient safety, community-acquired pneumonia and end-of-life care are scheduled to begin in several regions during the next six months.
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Kupper Parker Communications

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