For Wichita’s Via Christi Hospital St. Francis to earn certification last year as a Comprehensive Stroke Center by The Joint Commission, it had to demonstrate it had the specialized stroke care team and protocols in place 24 hours a day, seven days a week, to care for even the most complex strokes.
From the left are first responders Angela Hamilton, Sarah Cindric and C.P. Morgan; stroke survivor Kelby Harrison; and Via Christi Comprehensive Stroke Center team members Cynthia Johnson, RN, and LeighAnn Persondek, APRN
It also required a commitment to serving as a regional leader for advanced stroke care by not only maintaining its excellent outcomes but also continuously finding ways to improve them.
“Since becoming a Comprehensive Stroke Center, we’ve been focused on further improving door-to-treatment times for acute stroke patients,” says Saad Kanaan, MD, who serves as its Medical Director.
Sedgwick County firefighter Kelby Harrison is living proof of several of the improvements Via Christi has made this past year in stroke triage and treatment.
First, his fellow firefighters and first responders recognized he was exhibiting acute stroke symptoms and needed to be taken to a healthcare facility capable of providing the highest level of stroke care. Second, first responders called in a pre-hospital alert so that a Via Christi stroke team could assemble and be ready to treat Harrison the minute he arrived. Third, he was taken directly to CT scan in the Emergency Department — and subsequently treated with IV tPA within 30 minutes, followed by endovascular clot retrieval.
Harrison’s stroke — suffered in the parking lot of a local YMCA after a workout with co-workers — was caused by a blood clot in a large artery in the brain. Two days after having undergone a successful stroke revascularization, Harrison was discharged home with outpatient therapy. He was back to work less than two months later.
Making It Even Better
Via Christi is one of only two Kansas hospitals to achieve certification as an Advanced Comprehensive Stroke Center, which typically is the largest and best-equipped hospital for treating acute stroke and other neuroendovascular diseases within a particular geographical area. The other is the University of Kansas Medical Center, in Kansas City.
In 2016, Via Christi’s Comprehensive Stroke Center at St. Francis treated 700 stroke patients, including 550 with ischemic strokes and 150 with hemorrhagic strokes, and received stroke transfers from more than 60 Kansas hospitals.
As a Comprehensive Stroke Center, Via Christi continues to work within its doors, as well as its community, to improve stroke treatment and outcomes.
In 2016, the average door-to-needle time at Via Christi was 42 minutes — a seven-minute improvement over the prior year — “and five minutes less than the national average when compared to other Comprehensive Stroke Centers in Get With the Guidelines,” notes Kristina Willour, RN, who serves as Stroke Program Coordinator.
When 2 million brain cells die every minute, time is brain. Therefore, faster door-to-treatment times, which lead to better patient outcomes, have come as a result of efforts to help pre-hospital staff and staff from transferring facilities recognize complex stroke situations early. Consequently, those staff members, like the local EMS crew who transported Harrison, can let the Via Christi team know an acute stroke care patient is en route.
In January — based on Via Christi’s performance of surpassing national guidelines and its diagnostic and treatment protocols as a Comprehensive Stroke Center — the Medical Society of Sedgwick County endorsed routing the most complex stroke patients to St. Francis. “With that, we’ve started working with emergency medical services on how to identify complex strokes,” says Dr. Kanaan, including screening for potential large-vessel-occlusion patients and preferentially routing them to the Comprehensive Stroke Center — a decision that is having a positive impact on endovascular treatment times.
“In March, the AHA published a similar triage algorithm about preferential routing for potential large-vessel-occlusion strokes to a Comprehensive Stroke Center if it does not delay treatment,” says LeighAnn Persondek, stroke program APRN. This algorithm will lead other EMS crews to adopt this protocol.
With the pre-arrival vascular team notification, which became standard in January as well, early data shows that Via Christi’s door-to-puncture times for endovascular treatment have improved by almost 20 minutes over its 2016 times. “For 2017, we’re at 87 minutes door-to-puncture time, which is a minute faster than the national average for Comprehensive Stroke Centers,” Willour says.
And that, notes Dr. Kanaan, means that patients coming to the Via Christi Comprehensive Stroke Center receive timely stroke care that’s close to home, with outcomes comparable to the best of the best centers nationwide.
Access to Technology, Treatments and Training
When Harrison, the firefighter, was brought to Via Christi Hospital St. Francis, he was taken straight to the ED CT scanner, a step that, along with the pre-hospital notification, helped triage him through the system much quicker.
“Both have helped improve our treatment times,” says Dr. Kanaan.
Soon after his arrival, Harrison’s clot was removed by board-certified neurointerventional radiologist Kumar Reddy, MD, who serves as Medical Director for Neurovascular and Interventional Radiology. With more than 15 years experience, Dr. Reddy is credentialed and experienced at treating patients who suffer ischemic strokes, such as the one Harrison suffered, as well as patients with hemorrhagic strokes, brain aneurysms and other such conditions.
Standing left of stroke survivor Kelby Harrison is Kumar Reddy, MD, Medical Director of Neurovascular and Interventional Radiology at Via Christi, who retrieved the clot, and on the right is James Walker, MD, Medical Director of Via Christi’s dedicated 20-bed Neurocritical Intensive Care Unit, where Harrison received his care.
Although the effective IV tPA treatment window is generally up to four and a half hours, Dr. Reddy notes that at a Comprehensive Stroke Center like Via Christi’s, that time period can be significantly expanded.
“Using advanced imaging techniques, we have retrieved clots up to 12 hours after symptom onset,” he says. “For posterior circulation strokes, we can address clots up to 24 hours after onset. We are currently coming up with study protocols to extend the intra-arterial therapy beyond the standard six hours from onset, based on advanced imaging.”
“The technology we now have available has expanded the scope of endovascular treatments,” says Dr. Reddy. “These novel devices allow treatments of more complex aneurysms because of techniques such as balloon remodeling, stent-assisted coiling and flow diversion.”
While a giant brain aneurysm typically measures more than 25 millimeters, Dr. Reddy recently treated a 4-centimeter aneurysm, which was so large it was initially thought to have been a brain tumor.
As part of offering its full spectrum of stroke care, Via Christi provides education and training to help other facilities improve patient outcomes. The Stroke Center team also works with rural Kansas/community Kansas facilities on how to treat stroke patients and dispatch them, as appropriate, to the next level of care. As part of that commitment to education, Via Christi’s annual neuroscience symposium has been expanded to include a second day, to focus on stroke topics.
“Via Christi has long been a regional leader in stroke care, having invested in a dedicated Neurocritical Care Unit 15 years ago, and becoming the area’s first Primary Stroke Center 12 years ago,” says Dr. Kanaan. “They didn’t rest on their accomplishments then, and that pursuit of excellence continues today.”