When a former colleague suffered a stroke and did not receive treatment in time, it was a turning point for Hospital Cruz Roja in Cordoba. Their journey towards joining the stroke network in their region started with a call to Angels consultant Alicia Arjona ...
Working in a hospital means you see patients with all kinds of symptoms and ailments every day. The pandemic brought even more patients, many whom couldn't be saved. But what if a patient comes to the hospital with a peculiar type of stroke? And what if your hospital is not equipped to diagnose and effectively deal with such patients?
Even worse, what if this patient is someone you know personally, like a colleague for example? Would this experience break your spirit, or motivate you to make a change? In the case of Hospital Cruz Roja in Cordoba (HCRC) this experience has led to a new beginning.
A recently retired doctor from the hospital came into the emergency room reporting that he hadn't been feeling well for several hours. The doctors present mistook the symptoms for vertigo, a common stroke mimic, and as related to his previous atrial fibrillation history. He remained in the hospital to be monitored and cared for. When he later fell while trying to walk, they decided to take him to the CT room and discovered a cerebral infarction. By then, it was unfortunately too late to do anything against his stroke.
코르도바와 안달루시아 전체의 뇌졸중 코드는 뇌졸중을 뇌졸중 네트워크에 속한 공립병원에서 치료할 것을 명시하고 있습니다. 코르도바는 이러한 병원 중 한 곳인 종합 센터가 있으며, 코르도바의 다른 병원들이 뇌졸중 환자를 받는 경우에는 CT 스캔을 종합 센터에 보내 추가 지침과 이송을 요청합니다.
But Cordoba is a big city with a significant population to only have one stroke centre. That is why, despite being in the middle of a pandemic, the Intensive Care Unit lead by Dr Noelia Munoz and the Neurology Department lead by Dr Roberto Valverde of the HCRC decided to start treating stroke patients and implement a formal stroke code.
그들은 프로토콜에서 구현할 해결법과 다음 단계를 브레인스토밍하기 위해 해당 지역의 엔젤스 컨설턴트인 Alicia Arjona를 초대하였습니다. 이어서 역할과 상관없이 모든 의료진을 모아 목표를 발표하였습니다. 곧 새로운 환자 집단이 도착하는데, 모두 뇌졸중을 인식하고 진행 방법을 아는 데 필수 정보를 갖추어야 한다는 목표였습니다.
A multidisciplinary working group was created, called the Brain Team. "They truly understood the power of teamwork in stroke care," Alicia Arjona says. "They included everyone in the hospital in the development of the stroke pathway and trainings. And the team worked to make all understand they are an essential part of this journey."
The team developed a spirit of improvement and collaboration. Dr Munoz and Dr Valverde carefully organized trainings that could involve everyone without breaking any hygiene and social distancing rules.
Over several days in May, they taught staff the proper triage, the hyper-acute phase, the NIHSS neurological assessment, and the best practices in post-acute care. They chose the challenging goal of a 25-minute door-to-needle time; Helsinki posters were put in place to record data, and the use of checklists was established as part of the protocol.
Working with Angels, they also ran simulations consisting of two different scenarios – a Covid-19-negative stroke patient, involving EMS, and a Covid-19-suspected stroke patient who arrived at hospital on his own.
By May this year Hospital Cruz Roja had already successfully treated their first 10 acute stroke patients. Treatment takes place in the CT room, with the Stroke Bag at the ready, and the entire stroke team has regularly scheduled quality monitoring meetings to identify barriers and continue improving.
COVID-19 환자 수가 많아 뇌졸중 전문 병동에 병상을 배정할 수 없기 때문에 뇌졸중 환자들은 여전히 중환자실에 입원하고 있습니다. 그러나 그들의 목표는 여전히 병상을 배정하는 것이기 때문에 팬데믹이 나아지는 즉시 시행할 준비가 되어 있습니다.
Not only have links been strengthened between the hospital's porters, ED physicians, ICU physicians, EMS, nurses, neurologists, patient-data administrators and radiologists in the interests of better outcomes for stroke patients; the hospital has also adopted the Angels ideology and understand the importance of community. By sharing their story they want to give others the confidence to treat stroke patients, and encourage them to follow in their steps.
Dr Noelia Munoz는 다음과 같이 말합니다: "Angels helped with an implementation of a cultural change until good becomes better and better becomes the best. A chain is as strong as its weakest link... a chain of management and treatment of stroke patients in the hospital.
"We strongly believe in the chain of survival: It refers to a series of actions that, properly executed, reduce the mortality associated with these time sensitive interventions performed by people. It must be maximized and optimized so also the quality of life is included in this survival.
"We thank the patients for the daily life lessons. It was a stroke patient who gave us the opportunity to change our lives, more than us saving a stroke patient. We are now involved in this marvellous project because of him [the patient]".
