Time is Brain

Stroke, the fifth leading cause of death in the U.S., is the leading cause of disabilities, which makes recognizing the signs of stroke and seeking immediate treatment imperative. Recognizing the signs of stroke and calling 9-1-1 rather than having someone drive a stroke victim to the hospital could make a huge difference in treatment. But then, how fast does one get treatment after arriving at the hospital? In the arena of stroke treatment—time is brain. The faster the treatment, the more likely to minimize the damage to the brain. The time it takes to treat a patient struggling from stroke is exactly what is being tested in a simulation exercise set for December 14 at the Baltimore VA Medical Center, a division of the VA Maryland Health Care System. The early morning simulation focuses on patients arriving to the Emergency Department and the late morning simulation will focus on inpatients.

“The simulation will time the period it takes for a stroke patient to receive treatment from the time they enter the Emergency Department (ED) and also on the inpatient units from the time the code is announced,” said Augustine Hernandez, Educational Program Specialist for Employee Education at the health care system.

Before the simulation, clinicians, including physicians, nurses, identified facility educators, ED/Intensive Care Unit physicians and nurse trainers, trainers for radiology, lab and pharmacy, participated in a activation course in November that reviewed topics like recognizing stroke symptoms and why fast treatment matters, as well as logistical steps such as activating the stroke code, partnering with the telestroke team, and managing and handling technology related to treatment.

“This is an initiative with a main goal of improving stroke treatment by shortening the time it takes to recognize stroke and provide treatment” Hernandez said.

The goal of the simulation is to clock the amount of time it takes from the moment a patient enters the ED to when treatment starts and for it to take less than 60 minutes. While this 60-minute period is often referred to as “the golden hour,” a full diagnostic workup must be completed to rule out conditions that might mimic stroke. The key, said Hernandez, is identifying what kind of stroke the patient is having and then provide the appropriate treatment. “There are different kinds of strokes. Some are caused by a blockage, others by bleeding, another kind by clots, and in other ways.”

Identifying the kind of stroke and providing treatment within the shortest length of time can make a huge difference in patient outcomes. “Stroke patients have a greater chance of surviving and avoiding long-term brain damage if they arrive at the hospital and receive treatment within the first hour,” said Dr. Sandra Marshall, Chief of Staff at the VA Maryland Health Care System. “We are always working to improve the care we provide our patients, and this simulation allows us to learn more about our processes to see what a best practice is and what needs to be fine-tuned.”