Friday, June 13, 2014

Every second counts

EXTRAORDINARY CARE: From left, David Brown, MD, chief of the MGH Department of Emergency Medicine; Laurie Pagnottaro, MGH patient and guest speaker; and Schwamm

When it comes to treating stroke patients, every second counts which is why the MGH Acute Stroke Quality Taskforce has a motto – “time is brain.” American Heart Association standards suggest that hospitals strive to treat stroke patients within 60 minutes of arrival at an emergency department (ED), and in the fourth quarter of 2013, a MGH team trumped that national standard by obtaining a “door-to-needle” time for one patient of just nine minutes. 

The Door-to-Needle Time Campaign at the MGH – measuring the time from when a stroke patient arrives in the ED, until a doctor administers the clot-busting drug tissue plasminogen activator (TPA) – was launched in 2010 under the direction of Natalia Rost, MD, director of Acute Stroke Services. To date, the campaign has proven successful. In 2012, the MGH record was 16 minutes, and in 2011 it was 20 minutes.

The team of 13 caregivers who responded to the recent case in under 10 minutes was recognized and awarded for their efforts during the second annual MGH Acute Stroke Breakfast Gala. At the May 30 event, Lee H. Schwamm, MD, executive vice chairman of Neurology, director of the MGH Stroke Service and a leader in the Institute for Heart, Vascular and Stroke Care, attributed the record-breaking treatment to the hospital’s planning, preparation and readiness.

“This is a remarkable case,” Schwamm said. “First, for the timeliness of care and the dedication of ensuring that every patient gets this drug as fast as humanly possible; and second, for going that extra mile to make sure that patients have the opportunity to receive this treatment because it is so effective. The program we built here has become the model for a national campaign to improve door-to-needle time.”

Aneesh B. Singhal, MD, vice chair and director of Quality and Safety in the MGH Neurology Department and director of the Stroke and Neuro-ICU Observership Program, was the attending physician during the nine-minute door-to-needle treatment. Singhal said the MGH is now among the top performing high-volume centers in the Northeast and among the top globally as well.

“We are doing the right thing based on scientific evidence and plain logic,” he said. “We are developing an infrastructure to identify stroke and respond to patients’ needs as quickly as possible. To reduce the time to administer TPA and improve patient outcomes it has taken strong collaboration among paramedics, the ED staff, nurses, radiology teams, residents and the acute stroke fellow and attending physician. I think nine minutes is extraordinary. The system is clearly working.”

Read more articles from the 06/13/14 Hotline issue.


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