July 31, 2013
By Andy Hyland
|Colleen Lechtenberg, M.D.|
Patients in rural areas of Kansas are receiving better stroke care because of a statewide initiative that is helping train health care professionals on the most effective ways to respond to and treat a stroke.
Colleen Lechtenberg, M.D., an assistant professor in the University of Kansas Medical Center's Department of Neurology and the director of KU Hospital's Advanced Comprehensive Stroke Center, serves as the director of the Kansas Initiative for Stroke Survival, an initiative supported by the American Heart Association.
The high quality stroke care is usually available for patients in metropolitan areas in Kansas. The University of Kansas Hospital in Kansas City, Kan., for example, has been recognized as an Advanced Comprehensive Stroke Center by The Joint Commission. But Lechtenberg says patients who live in more rural areas of the state often aren't so fortunate, especially in a situation where time is extremely critical.
"With a stroke, time is brain," Lechtenberg says. "We're dealing with a situation where two million brain cells are dying every minute."
Another way to think of it is that for every minute's delay during a stroke, the brain ages three weeks, says Cherie Boxberger, director of quality and system improvement for the American Heart Association, who is helping to coordinate the program in Kansas.
According to the American Heart Association, stroke is the No. 4 killer of Kansans, and only 2 percent of Kansans with acute ischemic stroke receive an intravenous drug that is the recommended treatment for that condition.
The program has several goals, including getting more hospitals to administer the drug, tPA, to patients who qualify to receive it. Lechtenberg is the chairwoman of a statewide Kansas State Stroke Task Force, with 100 participating members from across the state. She brings her expertise and knowledge to the smaller hospitals in the state and helps them understand the latest treatments available.
KU Hospital partners with primary stroke centers at Stormont-Vail Regional Medical in Topeka, Saint Luke's Hospital in Overland Park and Via Christi Hospital in Wichita to provide support to smaller hospitals. That support includes making stroke doctors available to them on a phone hotline 24 hours a day, seven days a week.
The program aims to make hospitals "Emergent Stroke Ready," meaning they are much more prepared to handle a stroke patient who comes into the emergency room.
Emergent Stroke Ready hospitals have written protocols, a transport plan with one or more hospitals and the capability to administer tPA, the only FDA-approved treatment for acute ischemic stroke, to patients who qualify. They also collect data on stroke patients, and share it monthly with the Stroke Task Force.
Before the program, Kansas had 12 hospitals who met the criteria, all of them in Wichita, Topeka or the Kansas City area. Today, 58 hospitals in Kansas are Emergent Stroke Ready, and can be found all across the state. Early results show that 7.2 percent of patients now receive IVtPA treatments in Kansas, six months after the program.
One of the reasons the drug is administered to so few people is because it must be given quickly - within four and a half hours of a patient's last known normal symptoms. Many patients don't get to a hospital that quickly.
In fact, according to the AHA, more than half of all people in Kansas who die from stroke die before reaching a hospital, clinic or medical center. So the group is simultaneously working on an effort to get the word out about signs of stroke, too.
Knowing the signs of stroke - sudden difficulty speaking, sudden onset of numbness or weakness, sudden trouble seeing, trouble walking, dizziness, loss of balance and a severe headache with no known cause - can help save lives, Lechtenberg says, especially given the very limited amount of time available to work with.
"We're so bad at recognizing these signs," Boxberger says. "We go to bed. We think all stroke symptoms are solved by going to bed, and all our heart attack symptoms are solved by taking a Rolaids."
The program will be tracking results going forward, and the program leaders will be measuring how well they disseminate information about signs and symptoms, how many stroke patients receive the tPA drug treatments, how many people are transferred to hospitals with better stroke care options and - most importantly - an expected decline in the overall number of people who die from strokes in Kansas.
"Where you live shouldn't determine whether you live," Boxberger says.