MGH STROKE EXCELLENCE: Several members of the winning stroke care team and local EMT representatives
TIME IS BRAIN when it comes to treating stroke. National Institutes of Health standards suggest hospitals treat appropriate patients with intravenous tissue plasminogen activator (IV tPA) – a thrombolytic agent also known as a clot-busting drug – within 60 minutes of arrival in the Emergency Department (ED). Meeting this benchmark has been a priority for the MGH Acute Stroke Quality Task Force. This year, the task force is sponsoring the Door to Needle within 60 Minutes Campaign to recognize and help sustain recent improvements in the delivery of critical treatment to acute stroke patients arriving in the ED.
On Jan. 27, the task force held a recognition ceremony and breakfast for the care team with the fastest door-to-needle time – an astonishing 20 minutes – for the third quarter of 2010. “There was fast, clear communication between the ED and neurology teams and the technicians in the scanner,” says Allison Gray, MD, a neurology resident who was part of the winning team. “On that day, everyone was in synch.” Members of the winning team are Gray; Theodore Benzer, MD, PhD; Amanda Czuczman, MD; Onyinye Iweala, MD, PhD; Katharina Busl, MD; Katharine Stockton; Priscilla Stratiotis; Scott Silverman, MD; Frank Curtis, RN; Rachel Manning, RN; and Gaetano Pastena, MD. The breakfast also recognized the emergency medical technicians (EMT) from Armstrong Ambulance who transported the patient.
In 2009, more than 70 percent of eligible stroke patients were treated with IV tPA within 60 minutes of arrival at the MGH ED. In the first six months of 2010, that performance improved to more than 80 percent of eligible stroke patients. The average rate of tPA treatment within 60 minutes for academic hospitals in the United States was less than 30 percent in 2009.
“This is a remarkable achievement and reflects a considerable improvement from prior years,” says Lee Schwamm, MD, director of the Acute Stroke Service and vice chairman of the Department of Neurology. Schwamm credits a streamlined process that breaks down barriers between staff in the ED, neurology and computed tomography imaging, making them a uniform stroke team. Many of the changes the MGH has made are incorporated into the American Heart Association’s Target Stroke Campaign, which establishes best practices for hospitals working to reduce door-to-needle times.
“When the team is integrated, all parts can move in parallel,” says Schwamm. “We had to re-engineer our process of care and figure out how to make it truly patient-centered. We all had to give a little to be successful as a team. I am very proud to be able to work with such a talented and dedicated team of health care providers. These efforts have made us successful and led to the creation of evidence-based best practices.”
For more information about the MGH Stroke Service, access www.massgeneral.org/neurology/ services/treatmentprograms.aspx?id=1205.