On a mission to improve stroke care

In June, the Joint Commission certified Piedmont Henry Hospital as a Primary Stroke Center, meaning that the highest level of stroke care is readily available to Henry Countians and residents of the surrounding area.

A team of dedicated clinicians from many departments put the necessary processes in place to earn the stroke certification. But for one team member, it was a personal victory.

“When you can see a stroke patient come in with obvious deficits, can perform the necessary testing, give the right medication and watch him progress back to normal within three or four hours, it just makes me want to run around the block. I love it,” said Julie Espinosa, RN, MSN, clinical care coordinator in the emergency department at Piedmont Henry.

It’s the healing treatment her grandfather Rudolph Sevastien never had. Espinosa grew up in a small community on St. Croix in the U.S. Virgin Islands. Espinosa’s mother, a paramedic, was divorced so her grandparents took care of her and her siblings.

Espinosa was in her second year at the University of Miami when her grandfather had his first stroke in 1991. He returned home from the hospital, but with restrictions such as not being able to drive.

Espinosa returned home to help care for her grandfather. In 1992 he had a massive ischemic stroke that left him paralyzed on the left side and unable to speak.

“His brain was working, but he couldn’t get the words to come out. He just gave up after my daughter was born and died in 1994,” Espinosa said. “My grandfather was a huge figure in our family. A retired pharmacist, he took care of us. We had been so dependent on him. His strokes changed my family forever.”

An accounting major at Miami, Espinosa was inspired to help people and decided to become a EMT/paramedic. In 2007, she went back to school to study nursing.

Espinosa read about advances in stroke care but the local hospital in St. Croix couldn’t afford the staff, the proper imaging equipment or even the clot-busting drug, tPA. One stroke patient died after four days because the hospital staff couldn’t find another facility to take her.

To provide more opportunities for her children, Espinosa moved back to the United States in 2010 and was recruited by what was then called Henry Medical Center to work in the emergency department.

“They were in the early planning stages for stroke certification and putting the processes in place. I knew I was in the right place,” she said. “Stroke care isn’t just about the ER. The whole house has to have a plan in place and be working it. You are dependent on labs and imaging and training at all levels of care, and you have to work quickly as a team.”

Having helped her hospital in St. Croix become a certified chest pain center (by the National Heart Association), Espinosa enjoyed building the necessary networks and relationships between departments.

Reducing strokes

Being a Southeastern state, Georgia is in the Stroke Belt and has an unusually high incidence of stroke and other forms of cardiovascular disease. The state’s stroke death rate is 16 percent higher than the national average, according to the Georgia Department of Community Health, Division of Public Health.

Reducing the number of strokes is a key initiative of a recent Community Health Needs Assessment conducted by Piedmont Henry Hospital and county government and civic leaders.

“When you see a lot of something, you get better at treating it,” Espinosa said. “We were already consistently treating stroke, but joining with the Piedmont Healthcare system in 2011 gave us that added push. Having already gone down that road, Piedmont Hospital could serve as a mentor.

“They told us we were ready and to apply for certification. It’s like having a pretty red dress, but being afraid to put it on because you’re not sure how it will look. Piedmont said, 'What are you waiting for?’ So we put it on and it is beautiful.”

Piedmont Henry has made a new promise to the community: Arrive by 2, Treat by 3. That means if a stroke patient arrives within two hours of the onset of symptoms, he or she will be treated by the third hour — the most effective window to administer the tPA drug.

Time is especially important in treating strokes, and Piedmont Henry’s certification has made the emergency service providers in Henry County very happy, Espinosa said.

“There’s nothing you can do in an ambulance to treat stroke,” she said. “You want to transport the person to the best place in the least time. Now that place is 10 to 15 minutes away for our community.

“Within two weeks of our achieving stroke certification, the number of stroke patients coming here had doubled. Word had spread through the EMS community.”

For Espinosa, that means not only giving patients the best care, but helping families cope with the life changes that strokes bring. She seizes teachable moments to help families better manage hypertension or diabetes and to educate them about what to do if they see stroke symptoms.

“Knowing that we’re giving optimal care feels good on so many levels,” she said. “We’re very proud of this certification.”

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