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Every Second Counts in Stroke Treatment

September 15, 2017

Overlook Medical Center’s Comprehensive Stroke Center surpasses the highest standards and requirements for treating stroke, leading to better outcomes for patients

Overlook’s Comprehensive Stroke Center surpasses the highest standards and requirements for treating stroke, including the use of telestroke, an interactive video tool, both in the ambulance and the emergency department; advanced imaging capabilities, including a 320-slice CT scanner; 24/7 availability of specialized treatments (i.e., mechanical retrieval devices); a neuro ICU; and staff with the unique education and competencies to care for even the most complex stroke cases.

As a result, Overlook Medical Center serves as the region’s Comprehensive Stroke Center, receiving patients from more than a dozen Primary Stroke Center hospitals in New Jersey. This network enables our team of expert neurophysicians to share state-of-the-art stroke diagnostics and treatment technologies with colleagues at other facilities, ensuring that their stroke patients receive the best possible medical care. Patients who require advanced interventions receive well-coordinated and rapid transport to Overlook.

Winning the Race Against Time

An ischemic stroke occurs when blood flow to the brain is interrupted, resulting in the death of two million brain cells per minute, explains Gary Belt, MD, a stroke neurologist at Overlook Medical Center’s Atlantic Neuroscience Institute. “It is essential to reestablish blood flow as quickly as possible to limit the damage,” he says. “Thus, the adage ‘Time is brain.’ Every detail in the treatment of stroke is crucial.”

The overarching goal with stroke is to treat each patient quickly and safely in order to minimize any long-term effects. The first line of defense in the treatment of ischemic stroke is IV alteplase (tPA), a powerful clot-busting drug that can be delivered up to four-and-a-half hours after the onset of stroke.

Unfortunately, only 10 percent of ischemic stroke patients nationwide receive alteplase, but across Atlantic Health System, 18 percent of our ischemic stroke patients receive the treatment. Consider, too, “door-to-needle time” – the amount of time that passes from the point a patient enters the hospital to the point he or she receives alteplase therapy for stroke.

In the United States, 72 percent of these patients have a door-to-needle time less than 60 minutes. Far fewer – just 39 percent – are treated in less than 45 minutes. Treatment times in New Jersey match both of these statistics.

But across Atlantic Health System, we surpass top performance on nationally set metrics for stroke care: 87 percent of our patients have a door-to-needle time less than 60 minutes. Even better: Of the more than 800 patients treated for stroke at Overlook last year, 78 percent of those receiving alteplase were treated in 45 minutes or less. In fact, door-to-needle times at Overlook have registered as low as 12 minutes, rivaling numbers at any health care facility worldwide.

How We Achieve This

Our culture of stroke care reaches patients even before they come through our doors, and extends to every area of the hospital. Patient transitions between professionals are tight. Each step has been evaluated with an eye toward efficiency and safety.

Key to our success are our relationships with local EMS squads, as well as the use of telestroke in our ambulances. This wireless video technology allows for a rapid neurological evaluation before a patient arrives at the emergency department. Through telestroke, one of Overlook’s dedicated team of stroke neurologists is on call 24/7 to view and communicate with the patient and the EMTs in the ambulance – just as if the physician and patient were in an exam room together at the hospital. If a stroke is suspected, the physician alerts Overlook’s emergency department to activate the hospital’s stroke team so that everything is in place for the patient the moment he or she reaches Overlook’s doors. This eliminates 10 minutes or more in the time from transport to treatment – and preserves millions of healthy brain cells in the process.

In November 2016, Overlook opened its helipad – specifically to expedite the care of patients with acute stroke and other neurologic emergencies.

John Halperin, MD, chair of neurosciences for Overlook, states: “Having the helipad allows us to speed care of patients at greater distances from Overlook, placing more patients in the time-critical window of opportunity during which interventions can save brain cells and save lives. Minutes saved in transport – whether by ambulance or by air – can lessen the severity of brain damage.”

At Overlook, stroke patients are admitted to a stroke unit supported by a multidisciplinary team that includes physicians, nurses, radiologists, pharmacists, rehabilitation services, social workers, case managers, and others.

A 320-slice CT scan – the most advanced of its kind – is used to exclude bleeding in the brain or problems other than an acute stroke, as neuroradiologists are able to visualize any obstruction or rupture in the brain. Patients who are not able to receive alteplase – whether they are outside the four-and-a-half-hour window of time or for other reasons – may instead be candidates for neurosurgical mechanical intervention.

 Endovascular neurosurgeons at Overlook are able to perform “stenttriever” procedures, in which clots are removed mechanically through a catheter and stent threaded from an artery in the groin to the blockage in the brain. The neurointerventionalist visualizes the procedure in real time through angiography. When the stent reaches the blockage, it opens the vessel, and the stent and the clot are pulled out through the catheter together.

Awards and Accolades

A comprehensive, multidisciplinary approach has propelled Overlook to the forefront of stroke care in our region. Overlook is recognized by The Joint Commission and the American Heart Association/American Stroke Association (ASA) for meeting The Joint Commission’s standards for Disease-Specific Care Comprehensive Stroke Center Certification, which means it is part of an exclusive group of providers with state-of-the-art infrastructure, staff and training to receive and treat patients with the most complex strokes.

Additionally, Overlook is the only hospital in New Jersey to be recognized as one of “America’s 100 Best Hospitals for Stroke Care™” and “America’s 100 Best Hospitals for Critical Care™” in 2016 by consumer health care ranking group Healthgrades®.

The awards and accolades are welcome signs of success, acknowledges Carla Errico, neuroscience manager, but she stresses that the focus is always on doing more and doing better. “Time is brain, so we never let up,” she says. “We’re always looking at ways to improve, because we know that every improvement means a better outcome for our patients.

Think FAST

The key to faster treatment is correctly identifying stroke symptoms. The ASA, along with the American Heart Association, suggest the FAST approach. If individuals notice three symptoms – face drooping, arm weakness and speech difficulty – it’s time to reach for the nearest phone.

“If you think you or someone you know is having a stroke, it’s a medical emergency,” says Dr. Belt. “Call 911 immediately.”