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December 16, 2009 > Team Effort Drives Better Stroke Outcomes

Team Effort Drives Better Stroke Outcomes

Timely and effective treatment of stroke can mean the difference between serious disability and an active lifestyle, between returning home and living in a long-term nursing facility - and even between life and death.

That is why to ensure the best possible patient outcomes, the Stroke Program at Washington Hospital offers the most current approach to treating stroke patients, using the latest technology.

But the program would not exist without the people to support it. The program has been a success because of the unwavering support of the Washington Hospital's leadership team, as well as medical staff and hospital staff throughout Washington Hospital Healthcare System, says Dr. Ash Jain, M.D., medical director of the program.

"Our Stroke Program draws on the skill and expertise of professionals throughout the hospital," according to Dr. Jain. "The program has been developed to take into account every stage of care, from the moment emergency medical services (EMS) reach the patient."

Achievements in 2009

In May, Washington Hospital's Stroke Program received the Silver Performance Achievement Award as part of the American Stroke Association's (ASA) Get With The Guidelines-Stroke (GWTG-Stroke) program, a national evidence-based initiative to improve stroke patients' outcomes. The ASA program recognizes hospitals across the country whose stroke treatment programs have shown consistent compliance with measures proven to improve outcomes.

In July, The Stroke Program received bi-annual recertification from the Joint Commission, earning its Gold Seal of Approval for the second time. The Gold Seal of Approval signifies that the services means the hospital's protocols for treating stroke patients meets the standards of the best programs in the country. A premiere symbol of quality, Joint Commission certification is awarded to stroke care programs that make exceptional efforts to improve long-term patient outcomes and that meet rigorous standards for continuously upgrading the safety and quality of patient care.

When a patient arrives in Washington Hospital's Emergency Room with a potential stroke, doctors and specially trained stroke nurses are ready 24 hours a day to quickly diagnose and begin treatment focused on evidence-based, scientifically researched standards of care, which have been shown to result in improved clinical outcomes.

"Physicians and nurses have developed protocols to make sure that this group of patients gets prompt attention in the emergency room," Dr. Jain says.
To properly diagnose and treat patients, a number of tests must be run quickly and efficiently. Dr. Jain credits the hospital's Laboratory Services and Medical Imaging departments for ensuring that treating physicians have results as promptly as possible.

"At this stage of care, the neurologists make sure that patients receive appropriate treatment," says Dr. Jain. "They come in at any time, day or night to evaluate and treat stroke patients. Without them the program would not exist."
Should an emergency arise, Washington Hospital Medical Staff neurologists Dr. Prabhjot Singh Khalsa, Dr. Charan Singh and Dr. Ravinder Kahlon are on-call to evaluate and treat stroke patients in a short window of time.

"There is a three-hour treatment window from onset of stroke symptoms," Dr. Kahlon says. "Once the patient is in the ER, medical evaluation has to be done fast; then the neurologist is called to see if the patient is a candidate for tPA administration."

Tissue plasminogen activator (tPA) is a thrombolytic agent more commonly known as a clot-busting drug. The drug can dissolve blood clots, which cause most heart attacks and strokes. Though very effective in certain cases, tPA must be administered within a very short timeframe, which makes timely evaluation of patients by a neurologist crucial.

"We can be called into the hospital any time of the night or day; we are on-call for that purpose," Dr. Kahlon says. "After admission in the hospital, we follow the patient on a daily basis for reevaluation and to plan for follow-up treatment. The neurologist's role begins in the ER and then continues if the patient is admitted to the hospital, as well as dealing with the family members because stroke not only affects the patient but also the family."

According to Dr. Singh, Washington Hospital has adopted a very aggressive approach to stroke education and rehabilitation.

"The stroke team comprising of the neurologist, stroke RN and nurses on certain floors are all especially trained toward educating the patient and their family about stroke," she says. "Rehabilitation is the next major step toward recovery and all our stroke patients receive intensive rehabilitation from the hospital."
Dr. Kahlon credits a greater community awareness of the signs and symptoms of stroke to the Stroke Program's quarterly Stroke Education Series, as well as continuous programming on the hospital's cable channel, InHealth, which is broadcast on Comcast Channel 78.

"It is vital for the hospital to recognize the importance of stroke awareness in the community has been vital," Dr. Kahlon says. "There are many factors that contribute to better outcomes including early treatment in the ER and ongoing community stroke education in the form of lectures and information on the TV channel. We have some patients' families who say 'I know about tPA from the TV channel' or 'I attended a stroke education program.'

"People are more aware of stroke because of these programs."

Improving stroke outcomes

To learn more about stroke care at Washington Hospital, visit, click on "Services," and choose "Stroke Program." This article is also featured in the current issue of Health Signs, a quarterly magazine published by Washington Hospital Healthcare System. If you would like to be added to the Health Signs mailing list, please call Washington Hospital's Community Relations Department at (510) 791-3417.

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