AcuteCare Telemedicine Blog

Its Black and White: A Neurologist Saves the Gray
November 3, 2011, 6:06 pm
Filed under: Telemedicine | Tags: , , , , ,

Time is brain. Every minute during a stroke 2 million brain cells die. Starved of oxygen, neurons die when a blood clot blocks an artery. The outcome is disability and even death.  Administration of the “clot-busting” drug Alteplase (i.e. thrombolysis) within 3 hours can restore blood flow and brain cells…life. Neurologists, at the core of an acute stroke intervention team, can save brain by saving time.

The gold-standard for measuring the efficiency of acute stroke care is the time “from door to needle.” That is, the time from when a patient arrives to the emergency room to the time medication is infused with a goal of <60 minutes. However, for a neurologist to truly minimize disability a cascade of crucial steps must begin in the field with Emergency Medical Services (EMS). The emergency room (ER) must stand ready at all times to accept and treat an acute stroke.  Meanwhile, the coordinated efforts of laboratory, radiology and pharmacy staff will determine when, or if, life-saving medication is given.

Neurologists, particularly Directors of Stroke Services, are charged with the responsibility of putting a coordinated plan into place ahead of time. Stroke outcome improves when EMS notifies the ER that they are transporting a possible thrombolysis patient. Subsequently, meeting the stroke patient at the ER’s ambulance bay for immediate transport to the CT table can result in door to needle times of less than 20 minutes. Assuring stroke patient’s blood samples are given priority in the laboratory, alerting the on-call radiologist before the CT is completed and premixing thrombolytic drugs in the ER are also crucial steps in an efficient acute stroke intervention.

Neurologists also benefit future patients by rigorously reviewing the outcomes of previous stroke interventions. Scheduled meetings of a multidisciplinary “stroke team” reinforce good practices and identify inefficiencies. Ultimately, patients benefit because neurologists are taking leadership roles in the planning and implementation of acute stroke care.

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