Via Christi Hospital St. Francis in Wichita recently became the second hospital in Kansas to earn designation by The Joint Commission as a Comprehensive Stroke Center (CSC), the highest level of stroke care certification offered by the independent accrediting and certification agency.
It’s a significant step for Via Christi and the patients and families from throughout Kansas and the surrounding states it serves — one that’s part of a 10-year journey toward becoming a center of excellence for stroke care.
That journey began in 2005 when Via Christi became the area’s first and for several years only hospital to earn and maintain designation as a Primary Stroke Center.
In 2012, The Joint Commission, in collaboration with the American Heart Association (AHA) and American Stroke Association, introduced certification as a Comprehensive Stroke Center — an even more elite standard of care.
Now, Via Christi, which also is one of only two AHA-designated 24/7 interventional stroke centers in Kansas, has successfully demonstrated that it has the system in place as well as the extensive experience and resources needed to treat even the most acute stroke cases.
Via Christi’s Comprehensive Stroke Center team, alongside Eagle Med, one of the air medical transport services that brings them patients
“We stand ready to provide all levels of care for patients seven days a week, 24 hours a day,” says Saad Kanaan, MD, the board-certified neurologist who serves as Medical Director for the Via Christi Stroke Center, which integrates prevention and outreach, research, and rehabilitation services into its system of care.
As a result, patients and healthcare professionals statewide benefit from having a premier CSC closer to home, whether they are seen in one of Via Christi’s three Wichita ERs, access the Via Christi Stroke Center’s services through consultation with providers at their community hospital or come to St. Francis via medical transport.
On the forefront of care
During its decade as a Primary Stroke Center, Via Christi assembled the well-trained, specialized multidisciplinary team of healthcare professionals needed for adult stroke patients. That ranged from a team of specialty-trained advance practice nurses and physician assistants working with neurocritical care-designated intensivists in house 24/7 and specialty-trained front-line nursing staff and board-certified neurologists and hospitalists, to professionals needed in ongoing after-stroke care, such as physical and occupational therapists and case managers.
The Via Christi Stroke Center also honed its ability to deliver timely and successful drug and surgical treatments for both ischemic and hemorrhagic stroke patients, and opened the region’s only dedicated 20-bed neurocritical care unit at St. Francis. It also acquired advanced imaging technologies that it can use for diagnoses and treatments.
During that time, Via Christi has been recognized for quality care, most recently with a Silver Plus Target Honor Roll-Elite Award by the AHA. This award recognized Via Christi not only for its consistency in complying with stroke treatment quality measures, but also for its timeliness in giving tissue plasminogen activator (tPA).
This time-sensitive treatment, often referred to as IV tPA because it is given intravenously, is the only FDA-approved treatment for ischemic strokes, which occur when a vessel supplying blood to the brain is obstructed. If tPA is administered within three — or in certain cases within 4.5 — hours, it greatly increases the patient’s odds of recovery.
But sooner is better, according to the medical literature.
“It is well-known, based on most recent studies, that patient outcomes are largely dependent on how soon this medication is given,” says Dr. Kanaan.
Via Christi has been highly successful in administering tPA quickly. National guidelines, set by the AHA, recommend that hospitals administer IV tPA within 60 minutes of eligible patients’ arrival. While a 2014 study in JAMA found that less than one-third of patients presenting with acute ischemic stroke were treated within those door-to-needle guidelines, that has not been the case at Via Christi.
For calendar years 2013 through 2015, door-to-needle average times at Via Christi have remained below those guidelines. In 2015, the average door-to-needle time was less than 50 minutes.
While fast administration of tPA is important, it is only one mode of stroke treatment.
“Some ischemic stroke patients require even more complex interventions, including surgery, or advanced reperfusion procedures. Guidelines now recommend in specific cases endovascular clot retrieval for ischemic stroke,” says Kristina Willour, RN, Via Christi’s Stroke Program Coordinator, adding that treatment options for hemorrhagic stroke, or brain bleed, often involve surgical or endovascular intervention as well.
Improving stroke care statewide
The Joint Commission has three levels of stroke care certification, including the first-tier certification of emergent stroke-ready centers.
For the past 10 years, Via Christi has partnered with other Kansas hospitals, providing them with the stroke education and support they need to develop or enhance their stroke programs and community preparedness.
With time to treatment being such an important factor in the long-term health and survival of a patient, more Kansas hospitals are becoming emergent stroke-ready centers, where patients can be given IV tPA and then transported to a higher-level care center, such as Via Christi’s CSC.
(L-R) Justin Sandall, DO, Chair of the Via Christi ICU Committee; Saad Kanaan, MD, Medical Director for the Via Christi Stroke Program; James Walker, MD, Medical Director for Via Christi Neurocritical Care; and Kumar Reddy, MD, Medical Director for Via Christi Neurovascular and Interventional Radiology
Via Christi’s stroke team often consults with staff at those originating hospitals as they assess the best treatment protocol, including the administering of IV tPA. As a CSC, the Via Christi Stroke Center team will continue to work both to improve its own treatment times and help surrounding hospitals become better equipped with protocol-driven acute stroke evaluation, treatment and transfer guidelines.
The Via Christi Stroke Center team is available to consult on acute stroke via hospital dispatch 24/7. For more information, call 800-353-3111.