It takes a good team to treat a stroke

By Laura Raines

Pulse editor

It takes a strong team of specialized professionals to treat strokes, and Grady Memorial Hospital in Atlanta has one. In 2005, Grady became the first “safety-net” public hospital in the United States to be certified as a primary stroke center by the Joint Commission.

Thanks to a $20 million gift from the Marcus Foundation, the stroke team has operated at Grady’s new Marcus Stroke & Neuroscience Center since it opened in March. Staff members say the funds will allow them to advance their oustanding stroke care even further.

“This is definitely not the old neuro unit,” said Jason Faggard, BSN, RN, who works in the 18-bed intensive care unit, which is across the hall from a 20-bed stepdown unit. “The new rooms are so spacious and the equipment is state-of-the-art.”

Previously, families could only visit ICU patients sporadically, but the new rooms have a resting area for families.

“Stroke is scary for patients and their families,” Faggard said. “There are so many unknowns.

“A family-centered care model, which allows families to stay with their loved ones, is better for everyone. It will make it easier for us to comfort, guide and educate patients and their families.”

Nurses can explain the purpose of complicated ICU machinery, allaying fear and worry.

Family-centered care allows families to be present when doctors, nurses and therapists make patient rounds, said Marlene Holmes, ADN, RN, charge nurse.

“They’ll be able to take part, ask questions, even watch in-room therapy sessions,” she said. “Patients need that support. Once they leave the hospital, they’ll need their families to be active in their care, so why not let them start in the hospital?”

Holmes encourages family members to talk to unconscious patients and hold their hands. She believes small things make a difference.

“I’m a big fan of music therapy and [I] encourage families to bring a patient’s favorite music,” Holmes said. “Our new Stryker beds make it so much easier to transport and care for a patient, and they also have a music function. Nature sounds — like waves — can create a soothing environment in the ICU.”

The ‘war room’

Faggard has dubbed the nurses’ station “the war room” because of flatscreen TVs that allow nurses to constantly monitor patients’ inner-cranial pressure, oxygen-saturation levels, EEG (electroencephalogram) results and other vital signs. A CT scanner and angiogram suite are right down the hall, which speeds up treatment procedures like venting (to relieve swelling and pressure in the brain) and coiling (to break up clots).

“Nurses will go with their patients, which means that instead of reading the report, they’ll see the results and can talk to doctors directly, which will improve the continuum of care,” Faggard said.

“In stroke treatment, every minute counts because there is a critical ‘golden hour’ to save the brain,” said Dr. Michael Frankel, chief of neurology for Grady Health System.

At Grady and other certified primary stroke centers, it’s standard procedure to alert the stroke team when a patient is in route to the emergency department.

“Everyone gets the page — the nurses, ECC techs, neurologist, radiologist, etc., and we all follow evidence-based pathways for care,” Holmes said. “Stroke can be a very long process — from initial diagnosis, through stabilization, ICU and recovery.

“Even if the patient makes it within the 41/2-hour window for TPA (a powerful blood clot-busting drug), the first 24 hours is very intensive nursing.”

Holmes is “personally ecstatic” to be part of the first team to work in Grady’s cutting-edge center.

“The brain is so complex that you are amazed every day,” she said. “No two days or patients are ever exactly alike, and I really like that.

“I also love the autonomy in stroke care. Doctors listen to nurses, because they know we’re at the bedside and they value our opinion. It’s a joint venture.”

Lines of communication

Good communication results in better care, said Cheryl Stewart, MA, SLP/CCC, a speech language pathlogist who has worked at Grady for most of her 25-year career.

“It’s going to be easier to communicate here, because we’ll see more of each other,” she said. “I’ll be able to tell nurses and families directly about my observed changes.”

Speech language pathlogists often get called in to evaluate stroke patients in the emergency department.

“Someone may have been there for many hours and wants food and water, but nurses and doctors don’t know if it’s safe, so I do a swallow screening,” Stewart said.

Later, Stewart will re-evaluate the patient and formulate a plan to work on cognition, speech and language abilities, and/or swallowing, depending on what is needed.

“There is never a boring day with stroke. You learn something every day,” Stewart said.

She knows that even though lesions can occur in the same area of the brain, patients have unique deficits and outcomes.

“I thrive on seeing the results of my work. When a patient comes back to visit and he’s walking and talking, it gives me the greatest pleasure,” she said.

Walking and overall mobility is the focus of Mary White, MS-PT, a physical therapist for 28 years.

“Having state-of-the-art equipment and room to work — and making families part of the care plan — will be better for the patient and makes my job easier,” she said.

Once a patient is stable, a physical therapist is called in to assess abilities and deficits, and to set goals for recovery.

“The earlier we start, the better,” White said. “We may need to reteach a patient about body awareness or just get them to move to prevent deconditioning.”

White is also a neonatal ICU therapist and will divide her time between the stroke center and Grady’s neonatal ICU.

“This is the best of both worlds, because I love doing both,” White said. “There’s real satisfaction in helping people get better, and I really enjoy the teaching-hospital environment of Grady.”

Linh Do, OTR/L, had practiced occupational therapy for about a year before coming to Grady last November. She enjoys the interaction as well as the challenging nature of working with neurology patients.

“Every patient is different. You expect one presentation and something else happens; it keeps you on your toes,” she said. “I’ve been so impressed with the team here. They’re open to new techniques and ideas.”

Occupational therapy helps patients regain the ability to perform daily activities, including things people take for granted like eating and personal grooming.

“It’s hard to explain, because what we do is so broad, yet so specific to each patient,” Do said. “Someone may have a lot of strength, but no coordination.

“This is is a busy place, but people are willing to share their expertise. Everyone knows what they are doing and they’re compassionate.”

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