HILO — Just after 10:30 a.m. Friday a group of nurses, rehabilitation therapists and other medical providers gathered outside a room at Hilo Medical Center and discussed the care of their stroke patient inside.
When they finished, the group moved down the hall to the next room with another stroke patient.
Hospital officials said 25-30 stroke patients come through HMC’s doors each month.
Just this month, though, HMC began doing collaborative, interdisciplinary “grand rounds” for those patients in an effort to better coordinate care.
Becca Moore, HMC’s stroke/STEMI coordinator, said the rounds are an opportunity for care providers like nurses and physical, occupational and speech therapists “to see what kind of care we’re providing to each patient,” and learn what could have been done differently and where there’s room for improvement.
“At that time, if there’s any need from the doctors or something we’re missing, we can go ahead and discuss that,” she said.
Moore said rounding as an interdisciplinary team has been shown to have better patient outcomes.
“It’s really good. …It’s just a learning opportunity for us all.”
Registered Nurse Ridge Cabaccang, who has worked at HMC since October, said the rounds are helpful and allows for “extra eyes on the patients.”
Remi Tanouye, a registered nurse at HMC for six years, said coordinating care for stroke patients was more difficult before.
The new rounds protocol gets all departments on the same page “about what the patient needs, what’s going on with the patient, so the patient can get the best care,” she said.
Chief Nursing Officer Arthur Sampaga Jr. said the effort expedites care and prevents delays.
But the new protocol is just the latest update to stroke care provided at HMC.
In September, HMC was designated as a primary stroke center by the Joint Commission, an independent health care accrediting organization, a long-held goal.
“It means we’re held to a higher standard of care for each patient that comes in with a stroke symptom or stroke diagnosis,” Moore said.
There are 10 core measures HMC must follow with every stroke patient that comes in — including treating a patient’s stroke within 60 minutes of them arriving, she said.
“That’s the main one,” said Sampaga. “We want everyone to come to the hospital quick so they can get quick treatment within 60 minutes.”
According to Moore, every hour clot-busting medication is delayed is more than three years off of someone’s life and millions of brain cells are lost every minute.
“They say time is brain, so the longer you take, the more brain cells you lose to get treatment,” Sampaga said.
HMC started working towards the certification nearly a decade ago.
“Eight years ago we started the journey of wanting to be a stroke center and wanting to provide better care for our patients,” Sampaga said. “It took eight years and we’ve got stroke certified. With that, it increases the quality and the safety of our patient care and saves lives. The bottom line is it saves lives.”
There are approximately 240 stroke activations a year, he said. An activation “brings the team together” to expedite care.
Working closely with county EMS, Sampaga said first responders will call ahead when they pick up a stroke patient, “so our team is called, activated overhead on the speakers and our team will be waiting to receive the patient in the emergency room.”
In the past team members could be spread throughout the hospital, which Sampaga said would cause a delay in treatment.
Because they’ve been working toward the certification, Moore said HMC has been following those standards for more than a year. One of the biggest changes they’ve made has been following up with patients at one and three months, she said.
Know the signs
When it comes to recognizing the signs of a stroke, the American Stroke Association says to think F-A-S-T:
Face drooping — Does one side of the face droop or is it number? Is the person’s smile uneven or lopsided?
Arm weakness — Is one arm weal or numb? Ask the person to raise both arms, Does one arm drift downward.
Speech difficulty — Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence. Can they correctly repeat the word?
Time to call 911 — If someone exhibits these symptoms, call 911 and say “I think this is a stroke” to get to the hospital immediately. Note the time when the first symptoms appeared. Call even if unsure.
Other symptoms include sudden confusion, trouble speaking or understanding speech; sudden numbness or weakness of face, arm or leg, especially on one side of the body; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; sudden or severe headache with no known cause.
Email Stephanie Salmons at ssalmons@hawaiitribune-herald.com.
