Local hospitals developing new procedures for strokes

From The News Gazette

By Debra Pressey
Sunday, June 28, 2009 8:33 AM CDT

SPRINGFIELD – Doctors know how important it is for someone who's suffered a stroke to get speedy treatment.

Now Illinois hospitals that are prepared to offer the best and fastest care to stroke patients are being joined in a new network of primary stroke centers, and other hospitals throughout the state are being encouraged to join them.

Under recently-approved legislation (HB 2244) awaiting signature by Gov. Pat Quinn, hospitals and ambulance services in each emergency medical region throughout the state will develop their own triage and transport plans for stroke patients – which can include the option of ambulances bypassing the nearest hospital to take a stroke patient directly to a certified stroke center.

Both Carle Foundation Hospital and Provena Covenant Medical Center in Urbana are already working on stroke-center certification.

Provena United Samaritans Medical Center in Danville will operate under another designation recognized in the new law, an emergent stroke ready hospital, that can offer emergency treatment to stroke patients and then transfer them to a stroke center, according to Cindy Magsamen, HealthAware coordinator at Covenant Medical Center.

Stroke is a leading cause of long-term disability and the third leading cause of death in the U.S.

The emergency department at Provena Covenant Medical Center in Urbana. By Robin Scholz
Strokes are caused by either a blockage or rupture that disrupts blood flow to brain tissue. Fast treatment is critical, because nerve cells in the brain begin to die within three to four minutes, according to the American Stroke Association.

Sometimes it's already too late to treat the most common type of stroke – an ischemic stroke, caused by a clot – because common warning signs were overlooked and the patient wasn't brought to a hospital fast enough, medical experts say.

To administer a clot-busting treatment called tissue plasminogen activator, or tPA, a patient must be at an emergency room as quickly as possible after the onset of a stroke.

Most hospitals consider up to three hours after the onset of a stroke to be an effective window to administer tPA, but research is now showing tPA can be given up to four-and-a-half hours after the first sign of a stroke, according to Magsamen.

Delay beyond that, and "they've missed the opportunity," she said.

"Part of the real push is community education, so people can identify themselves as having a stroke and get someplace," said Ruth Madawick, director of regional outreach at Carle. "If they wait for symptoms to subside and go away, we've lost that ability to intervene."

State Rep. Bob Biggins, R-Elmhurst, knows firsthand how important it is to get prompt treatment. The sponsor of the stroke center bill, he suffered a stroke himself in downtown Chicago about five years ago, and got excellent care fast, he said. Two Legislature colleagues who suffered strokes and didn't get such prompt treatment weren't so lucky, he said.

Mark Peysakhovich, senior director of advocacy for the American Stroke Association's Midwest Affiliate, said tradition has always dictated that people in need of emergency medical care go to the nearest hospital.

"But as medical treatment advances, it's much more important to take the stroke patient not necessarily to the closest hospital but to the hospital that is reasonably close which would give them the best treatment," he said.

Studies have found stroke patients are less likely to die or need institutional care if an integrated system of stroke care was used, his organization says.

Currently 28 Illinois hospitals are certified stroke centers, according to The Joint Commission, a national organization that accredits and certifies health care businesses. The state plans to recognize Joint Commission certification for its own network of stroke centers.

Howard Peters, senior vice president of the Illinois Hospital Association, said the legislation establishes the basic infrastructure for stroke care and leaves it up to each region to work out the details based on its medical resources.

"The goal is that more primary stroke centers will be adopted," he said. "More will become emergent stroke ready and other hospitals will join in stroke networks and strengthen whole networks, to make sure people get to the right place and right care.

Madawick and Magsamen said Carle and Covenant are on track to apply for stroke center certification by the end of the year. Both hospitals are already meeting a lot of the requirements, they said.

The bill allows for planning time and more hospitals to become certified stroke centers. It establishes July 1, 2010, as the date for sending lists of all primary stroke centers and emergent stroke ready hospitals to emergency medical service medical directors in the state and posting the lists on-line.

"This will be a significant process. We don't expect it to take shape overnight," Peysakhovich said. "This is really the beginning of a fundamental shift in the way stroke is treated in this state."

Know the warning signs of a stroke

If you experience any of these signs, get to a hospital immediately:

— Sudden numbness or weakness in your face, arm or leg, especially on one side of your body.

— Sudden confusion, trouble speaking or understanding.

— Sudden trouble seeing out of one or both eyes.

— Sudden trouble walking, dizziness, loss of balance or coordination.

— Sudden, severe headache without a known cause.

Source: American Stroke Association

Primary stroke centers

Hospitals in Illinois that have been certified by The Joint Commission as primary stroke centers:

— Advocate Christ Medical Center, Oak Lawn

— Advocate Good Samaritan Hospital, Downers Grove

— Advocate Lutheran General Hospital, Park Ridge

— Alexian Brothers Medical Center, Elk Grove Village

— BroMenn Regional Medical Center, Normal

— Central DuPage Hospital, Winfield

— Decatur Memorial Hospital, Decatur

— Edward Hospital, Naperville

— Hinsdale Hospital, Hinsdale

— Ingalls Memorial Hospital, Harvey

— Loyola University Medical Center, Maywood

— MacNeal Hospital, Berwyn

— NorthShore University HealthSystem Evanston Hospital, Evanston.

— Northwest Community Hospital, Arlington Heights

— Northwestern Memorial Hospital, Chicago

— OSF St. Anthony Medical Center, Rockford

— OSF St. Joseph Medical Center, Bloomington

— Rockford Memorial Hospital, Rockford

— Rush University Medical Center, Chicago

— Rush-Copley Medical Center, Aurora

— St. Frances Medical Center, Peoria

— St. Alexius Medical Center, Hoffman Estates

— St. John's Hospital, Springfield

— SwedishAmerican Hospital, Rockford

— Methodist Medical Center of Illinois, Peoria

— University of Chicago Hospitals, Chicago

— University of Illinois Medical Center at Chicago

— Westlake Community Hospital, Melrose Park

Source: The Joint Commission

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