*disclaimer: Mission Control’s blog is not intended to provide medical advice. Please speak with a doctor or other healthcare professional before beginning, changing, or otherwise altering your healthcare plan.
Stroke is the fifth leading cause of death in the U.S., killing almost 130,000 Americans every year. It’s also a leading cause of severe disability. The National Stroke Association, and others in the healthcare field, devote the month of May to learn how to prevent strokes, increase the awareness of stroke symptoms, and how and when to seek care. May was formally deemed Stroke Awareness Month in 1989 by President George H.W. Bush.
One reason stroke can be disabling — and deadly — is because any time lost during a stroke means valuable care time is lost for the patient: Time is brain. The faster the healthcare team can diagnose the patient and get them to the right facility and with the right specialists, the better their chance at a positive outcome may be. Our case study, based on a fictional example, demonstrates how using Mission Control as a patient movement resource can make a critical difference when a patient with stroke enters your facility.
Case Study: Patient Movement Resource Makes the Difference in Time-Critical Stroke Cases
The Setting
It is a busy night in the 5-bed Emergency Department (ED). The ED Providers on hand are a Registered Nurse (RN) and an Advanced Practiced Registered Nurse (APRN), managing the workload like a well-oiled machine.
The night seems normal. A little past midnight a patient is discharged back to their nursing home. The other patients are stable.
The phone rings.
The Situation
Emergency Services (EMS) is on the line with a possible stroke patient on their way with an ETA of 15 minutes.
Patient Stats 58-year-old male Vitals 190/100 Heart rate 1150-130 BPM Positive stroke score*, including slurred speech and right-sided arm drift Blood sugar 130 Weight 280 lbs. *The Cincinnati Prehospital Stroke Scale evaluates symptoms of facial droop, arm drift, and abnormal speech. If one of those signs is abnormal, there is over a 70% chance the patient suffers from a stroke.
Patient History
EMS informs you that the patient is being treated for a thyroid disorder, hypertension, and hypercholesterolemia. He smokes 2 packs per day of cigarettes and is a truck driver. Home medications include thyroxine, atenolol, and statin (for low thyroid, high blood pressure, and high cholesterol).
What We Know
Patient Profile:This patient is at elevated risk for a stroke due to past medical history, being a cigarette smoker, overweight, sedentary lifestyle, and the findings of his 12-lead ECG shows the patient has intermittent atrial fibrillation with rapid ventricular response (heart in an abnormal rhythm and accelerated rate).
Next Steps
The APRN is assessing the patient. While you are drawing blood for the lab work-up, the CT technician calls and is ready for the patient. You notice other patients’ call lights on and hear on the scanner there is a two-vehicle motor vehicle accident (MVA) on Highway 36.
Priority-setting and critical thinking will be a must to get through the next several hours.
Possible Outcome — Without Mission Control
A few years ago, this situation would have felt chaotic. Stroke patients require time-intensive testing and monitoring that can keep a nurse and provider at the bedside for extended periods of time. The stroke patient’s speech is slowed, slurred, and at times garbled, so additional time is required to perform an appropriate assessment while providing compassionate care during a time-sensitive diagnosis. At the same time, we know “time is brain”, and getting the patient to and from the CT, labs drawn, NIHSS completed, takes time; all with the uncertainty of whether the patient’s condition will remain as is or decline.
Additionally, there are the needs of other patients in the ED. The nurse would be on the phone with the hospital’s transfer center to start the process of getting a neurologist to call the APRN. Furthermore, once an accepting physician was confirmed, there were more orders to give the patient a lytic (clot-dissolving) and blood pressure IV medication. The nurse is preparing the dosing of the lytic while on the phone with dispatch requesting air transport.
Multi-tasking is key, but distractions during lytic preparation is an unsafe practice.
Outcome — With Mission Control
Using Mission Control, the patient has multiple communication specialists working on his behalf, assisting with contacting and confirming the requested receiving hospital and securing appropriate transport for the patient while the nurse and APRN can for care him and the other patients. Knowing the MVA patients could arrive at any time, the care team needs to stay focused on patient care and getting patients transferred out of the ED appropriately. Mission Control staff will comment in the chatbox or call with any updates.
The patient NIHSS is 8 (stroke scale assessment) and the radiologist calls to tell the APRN the CT is clear. You know intravenous alteplase (the clot-dissolving medication) will be your next order from the APRN. The inclusion/exclusion checklist was completed, and you continue to work through the priorities of patient care in the ED. Mission Control connects the APRN and a potential receiving neurologist to discuss transferring the patient for advanced neurological services that are not provided at their hospital.
The patient was accepted by the neurologist, and it was decided by the providers to fly the patient, if possible, as they will assess him for a large vessel occlusion (the type of stroke present in this patient).
Mission Control was there to assist with getting transport arranged for this patient. As the flight crew is in the air, they started administering the clot-busting medication alteplase. We know that time is brain and getting this patient back to his family starts here with us.
Since the local EMS is out on the MVA, Mission Control arranged for another EMS agency to assist in picking up the crew at the airport. Finishing up on the transfer paperwork, the helicopter crew arrives and takes over care of the patient. Just in time, as local EMS calls to give report on the two code red patients they are bringing to the ER.
Thankfully, this hospital can handle these situations successfully thanks to the training and skill of the nursing staff and support from Mission Control.
Mission Control is a valuable resource. It assists in getting the appropriate resources for patients while allowing the staff to utilize their skills and training to stay focused on the patients.
In cases of stroke, time is brain. Mission Control helps ensure healthcare providers, EMS, and patients get access to the resources they need, when they need — when every second matters.
To learn more about Mission Control, click here.
Sources
Centers for Disease Control and Prevention https://www.cdc.gov/stroke/facts.htm
MAY is Stroke Month https://newsroom.heart.org/events/may-is-stroke-month
May is National Stroke Awareness Month: Learn the Signs https://www.columbianeurosurgery.org/news/may-national-stroke-awareness-month-learn-signs-lessen-effects/
May is National Stroke Awareness Month https://www.sophe.org/focus-areas/chronic-diseases/partnering-4-health/may-national-stroke-awareness-month/
Preventing Another Stroke https://www.stroke.org/en/life-after-stroke/preventing-another-stroke
