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The Delta Primary Stroke Center combined stroke awareness activities with a anniversary ribbon cutting in late May.

State now has 67 stroke hospitals working together to improve care

By BECKY GILLETTE

Cardiovascular disease (CVD), including heart disease and stroke, in Mississippi is the highest in the nation and the leading cause of death, accounting for more than one third of all deaths in the state, according to the Mississippi Department of Health.

But there are now 67 hospitals statewide that network together to provide care that not only saves lives, but can prevent long-term disabilities by providing the best treatment for stroke available.

“There is an enormous value in standardization of care across Mississippi,” said Rebecca M. Sugg, M.D., an interventional vascular neurologist who is director of the University of Mississippi Medical Center Comprehensive Stroke Center and chair of the Mississippi State Stroke System of Care Advisory Committee. “Our goal is to provide resources to help all hospitals provide the same high-quality stroke care across the state and a system of care to allow patients rapid assessment and transfer if a higher level of services is needed. In this way we can greatly increase the chance of a good outcome for each individual patient.”

The Mississippi Stroke Hospital program is just started to see data regarding the stroke death rate in Mississippi at participating hospitals. So long-term comparisons are not yet available.

“However, in participating hospitals we are proud that are overall mortality rate is lower than the national average for the first quarter 2016,” Sugg said.

The hospitals are ranked Level 1, Level 2, Level 3, Level 4, which are non-stroke hospitals that can’t treat stroke patients and should be bypassed by emergency medical services, said Mississippi State Healthcare Association (MHCA) Executive Director Dee Howard, R.N.

“The two highest functioning stroke hospitals are Level 1 St. Dominic and UMMC in Jackson,” Howard said. “These two hospitals have neurointerventionalists that are able to perform endovascular clot retrieval for ischemic stroke. Level 1 hospitals are also equipped with neurologists and neurosurgeons 24/7 and have a dedicated neurological intensive care unit that specializes in care of the acute stroke patients.”

Suggs said endovascular clot retrieval is most effective for patients with a large vessel that is occluded and when it is done as soon as possible from the onset of stroke. That is within six hours from time onset, and the sooner, the better.

Level 2 stroke hospitals have all that Level 1 hospitals have except for the ability to perform endovascular stroke therapy. Level 3 stroke hospitals are also known as “drip & ship” hospitals that can rapidly diagnose and risk-stratify the acute ischemic stroke patient for the clot buster drug Activase. Then the treated patient is transferred to a Level 1 or 2 stroke hospital based on hospital stroke transfer protocol. Level 3 hospitals may have telestroke capabilities to help the emergency department physician examine and treat the stroke patient.

“Stroke Hospitals are all to be collecting data via Get With The Guidelines-Stroke (GWTG-S) data registry, an American Hospital Association tool,” Howard said. “Mississippi hospitals are at varying stages of coming on board with this data registry as the Stroke System of Care has only been adopted by MSDH since October 2013. From the data we capture from the GWTG-S, the MSDH Stroke Performance Improvement Committee will review data quarterly and be able to see unblinded how each stroke hospital is performing.  The Stroke PI Committee will operate confidentially to make recommendations for systems and patient outcome improvement.”

Public awareness of the warning signs of stroke is critical because timely care greatly improves outcomes. The MHCA has initiated a statewide awareness campaign with commercials, community education, and media information.

“Activating 911 and getting to a hospital quickly increases the chance that patients can receive acute stroke treatments that are only safe within the first 3-8 hours from stroke onset,” Sugg said. “If patients receive these treatments, they are much more likely to recover function and have less disability.”

The Greenwood LeFlore Hospital recently had stroke awareness activities as part of a Delta Primary Stroke Center anniversary ribbon cutting.

“Cardiovascular disease is rampant in America,” said Lisa Byroads, a registered nurse and the stroke coordinator at Greenwood Leflore Hospital. “According to The American Stroke Association, stroke effects nearly 795,000 Americans every year.  Of those, approximately 5,000 will be Mississippians and 1,500 of those in our state will die from stroke. The scariest thing to me is, for every minute that a stroke goes untreated, 1.9 million brain cells are destroyed due to lack of blood flow.”

Byroads said it is estimated that 80 percent of strokes could be prevented.

“Stroke awareness is crucial in the prevention and treatment of stroke,” she said. “Everyone needs to know how to prevent a stroke, what the treatment options are, and where and how to get them. The more people we reach, the more informed they are.  Stroke treatments have changed significantly in the past 10 years. We now see people able to walk out of the hospital instead of having to spend the rest of their lives in a nursing home due to a devastating disability. That treatment is available only if the person comes to the hospital quickly, as soon as the stroke symptoms are noticed. From the time of symptom onset, there is a precious few hours to give the clot busting medication that can prevent a person’s life from forever changing for the worse.

“Our message to the public is get here fast,” she said. Call 911! Dial, don’t drive.”

For a list of Mississippi stroke hospitals, visit the website https://www.mshealthcarealliance.org/stroke-hospitals/.

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