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The expansion of a telemedicine program for early-intervention stroke treatments has helped Memorial Hermann Hospital in Houston bring life-saving drug treatments for clot dissolution to community hospitals across south Texas.

St. Luke’s Episcopal Hospital staffs its Houston base with a team of neurologists, neurosurgeons, radiologists, cardiologists, neurophysiologists, and emergency medicine and rehabilitative specialists — all dedicated to ’round-the-clock stroke in the precious few minutes that can make the difference between full recovery and death or permanent disability.

The two hospitals are among four across the state that in recent months have been accredited as stroke centers by the Joint Commission on Accreditation of Healthcare Organizations. Two Austin facilities in the SETON Healthcare Network — Brackenridge Hospital and Seton Medical Center — had earlier become the first Lone Star certifications announced by JCAHO.

Disease-specific certification

The stroke center hospital designation is part of JCAHO’s disease-specific certification process that also notes institutions earning high marks in asthma, diabetes, congestive heart failure, and other maladies.

“The reason for JCAHO’s creating this disease-specific accreditation process is to identify those institutions that are leaders in specific health care initiatives, [and] academic health centers want to differentiate themselves.” says Audrey Fisk, RN, MBA, CPHQ, director of neurosciences at Mem­orial Hermann.

Officials at that facility say they sought accreditation for the Memorial Hermann stroke center team, which is made up of neurotrauma specialists from the affiliated University of Texas Medical School– Houston, to encourage wider adoption of effective stroke treatments in the community.

Sandy Benitez, RN, nursing manager for the neuroscience and stroke units, says the biggest change since Memorial Hermann’s accreditation has been community awareness.

Public awareness

“More people know about our facility and are increasingly aware of how to recognize a stroke,” says Benitez. Campaigns to publicize the center, the symptoms of stroke, and the three-hour window to diagnose and administer the clot-busting tissue plasminogen activator (t-PA) have brought greater community awareness of the problem.

“Since the accreditation, we see more people,” says Fisk. “We already saw 47% of the stroke cases in this city. Two weeks ago, we saw seven strokes come through in about two hours, and that’s a really busy day. You have to have the best processes if you’re going to be challenged like that.”

Patients go from initial treatment in the stroke center to the neuroscience acute care unit, where emphasis is on recovery and preparation to begin therapy and rehabilitation, which are also available at Memorial Hermann.

Another prime reason for Memorial’s certification is the level of treatment. Along with a research team, James Grotta, MD, medical director for vascular neurology at Memorial Hermann and stroke program director for the University of Texas Medical School–Houston, helped develop t-PA, a drug that can reduce chances of permanent disability from strokes caused by clots.

Two types of stroke

Strokes can be clot-related or caused by the rupture of a blood vessel. Administering t-PA, a powerful blood thinner, to a patient suffering hemorrhagic stroke could be disastrous. A CT scan, along with expert interpretation, is needed for precise diagnosis. This, in part, accounts for the national average of 2% for t-PA usage, as compared with Memorial Hermann’s rate of 21%.

To increase the effective use of t-PA, Memorial Hermann directs emergency medical providers in the Houston area, as well as community hospitals in Beaumont, Orange, Lufkin, and Nacogdoches, through an innovative telemedicine program, extending state-of-the-art treatment of the nation’s third-leading cause of death.

According to JCAHO, t-PA usage is one of 10 measurements for evaluating a facility during certification. Besides procedures and medications for treatment and rehabilitation, the Joint Commission also measures public awareness and community education efforts that help produce good outcomes. The certification program is based on the “Recommendations for the Establishment of Primary Stroke Centers,” published by the Brain Attack Coalition, and on American Stroke Association statements for stroke to evaluate hospitals functioning as primary stroke centers.

An eye on process

“What they look at is how your whole process flow works throughout the organization,” says Fisk. “It takes a lot of people, not just the nursing units, to take care of stroke victims.”

JCAHO assesses each hospital’s flow of stroke treatment, from emergency assessment, admission, surgery, recovery, the rehabilitation process of speech, and physical and occupational therapy, all capped by apprising patients of their follow-up needs.

“These patients are at high risk after a stroke to have another, so they need to know what the risk factors are and how to prevent one,” says Fisk. “It’s about being educated [as to] what to look for and acting quickly. It’s all about saving brains.”

Janet Kilgore is a freelance writer.

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