Stroke Smart Medical Practices

Although the window for the most effective stroke treatment is incredibly short (3 hours), too many studies^* suggest that one in three stroke patients first calls their medical provider after stroke signs and symptoms begin. The patient may leave a message if the office is busy, and possibly hear back hours later. The patient may simply request an appointment for some time the next day, placing themselves well outside the treatment window. Although highly effective treatment for strokes is available when accessed in time, strokes remain the #1 cause of disability in the U.S. because people fail to recognize the medical emergency and don't call 9-1-1 immediately.

Strokes kill 2 million brain cells every minute--some of those brain cells allow us to speak, understand speech, feed ourselves, etc. and when they die, we are often left without those abilities. Stroke related disabilities are often avoidable if we receive care within the short treatment window. Although our primary care doctors play an indispensable role in our overall health, calling 9-1-1 is the most effective way to reach timely stroke treatment. This tendency of stroke patients to call their doctor rather than 9-1-1 increases their likelihood of suffering lifelong disabilities and underscores the need for each medical practice to become Stroke Smart. 

 

Medical practices have the potential to reach significant populations and offer authoritative guidance. A The Stroke Smart medical office... 

1) displays Stroke Smart magnets/wallet cards/posters in high visibility areas

2) offers callers a Stroke Smart voice message, naming stroke symptoms (i.e., sudden onset dizziness/loss of balance, vision changes, facial drooping, body weakness/numbness, etc.) and encourages the caller to hang up and immediately call 9-1-1 rather than leave a voice message or book an appointment if experiencing the symptoms

3) educates all receptionists/call takers to screen patients booking appointments for stroke symptoms, encouraging callers with those symptoms to immediately hang up and call 9-1-1

4) provides Stroke Smart education (identifying the patient's risk factors and highlighting the signs of symptoms of stroke, emphasizing the immediate need to call 9-1-1) during patient intake, while taking vitals and gathering patient history; a draft script is available here.

5) encourages each patient to become a Stroke Smart champion, educating others about the signs and symptoms of a stroke and emphasizing the need to call 9-1-1. 

A useful one-page document summarizing the components of a Stroke Smart medical practice may be accessed here.

A useful video for medical practice staff to watch to become Stroke Smart is here.

 Hospitals can BE THE CHANGE, reversing the tragedy of too many patients arriving too late to be eligible for stroke medication. Stroke Smart hospitals... 

1) ensure that everyone who works in the hospital, from medical staff to administrative staff, to maintenance staff, to support staff are all Stroke Smart through short, concise Stroke Smart training 

2) display Stroke Smart posters throughout the facility, i.e. in exam rooms, in waiting rooms, in break rooms, etc.

3) distribute Stroke Smart magnets and wallet cards to patients and visitors, making them easily accessible on tables and counters throughout the hospital

4) counsel each high-risk patient upon discharge of their stroke risk, educating each to know the signs of a stroke and to call 911 immediately if a stroke is suspected

 

^*Quotes from Relevant Studies

1) "The top three factors associated with delayed arrival [of stroke patients to the hospital] were if a general practitioner (GP) or primary care facility was visited first, referral from another hospital, and living alone."

The article is available here: If time is brain, where is the improvement in prehospital time after stroke? By Jeremy N. Pulvers and John D. G. Watson, Frontiers in Neurology, Mini Review published: 20 November 2017. The article may also be found online here:https://www.frontiersin.org/articles/10.3389/fneur.2017.00617/full

2) "2008 International Stroke conference found that, in 22% of cases, a patient or bystander's first response to stroke symptoms was to call a doctor, not an ambulance" furthermore, "A troubling study presented at the American Stroke Association's annual International Stroke Conference in February [2008] found that nearly a third of receptionists in primary care offices would, if talking to patients who reported classic stroke symptoms, direct them to come in for a visit later in the day, rather than telling them to call 911."

The article may be found here: Is your staff prepared to respond to a stroke? By J. Berthhold, ACP Internist. The research is also available online here:https://acpinternist.org/archives/2008/05/two.htm

3) "Almost 1 in 3 patients with a diffusion-weighted magnetic resonance imaging–confirmed ischemic stroke first called the family doctor practice. Face-to-face visits to the family doctor quadrupled the odds of prehospital delay. Efforts to reduce prehospital delay should address family doctors and their staffs as important partners in the prehospital pathway."

The article may be found here: Reasons for Prehospital Delay in Acute Ischemic Stroke Joachim Fladt, MD, et. al, Journal of the American Heart Association, October 2019, and is also available online here: https://www.ahajournals.org/doi/10.1161/JAHA.119.013101

4) "Time delays to ambulance call were significantly longer for stroke patients when a family physician was first contacted." The full article is available here. 

5) Be (and stay!) Stroke Smart: Systematic Review of Malpractice Litigation in the Diagnosis and Treatment of Acute Stroke