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How Tri-Valley hospital helps patients survive stroke

Stanford Health Care – ValleyCare's stroke program is recognized for its commitment to meeting rigorous national standards of stroke care.

- By Jack J. Lee

Prashanth Krishnamohan, MD, is medical director of the stroke program at Stanford Health Care – ValleyCare.
Enrique Mendoza

Time is of the essence when a stroke occurs. As many as 1.9 million neurons will die each minute until medication breaks up the clot that’s blocking or reducing blood flow to the affected brain area.

“The sooner you get to the hospital, the better,” said Denise Ferrer, a stroke quality specialist at Stanford Health Care – ValleyCare in Pleasanton, California.

Before the fall of 2019, emergency medical technicians transported Tri-Valley residents with stroke-like symptoms as far away as Castro Valley or Fremont. While there is a hospital that can receive stroke patients in nearby San Ramon, critical minutes can be lost transporting individuals from Livermore, Dublin and Pleasanton through Bay Area traffic.

Protocols dictate that EMTs must transport stroke patients to designated stroke centers, said Prashanth Krishnamohan, MD, medical director of neurology at Stanford Health Care – ValleyCare. While someone with stroke-like symptoms could walk into the emergency department and be treated there, they couldn’t be taken there by ambulance.

In the spring of 2019, Krishnamohan and Ferrer helped launch the stroke program at Stanford Health Care – ValleyCare, establishing a coordinated system for treating stroke patients. That fall, the hospital was certified as a primary stroke center by The Joint Commission, an independent nonprofit that evaluates and accredits health care organizations.

This certification affirms that a hospital has the capabilities to effectively treat stroke patients and is one of the criteria used by county health departments to determine which hospitals can receive stroke patients.

Stanford Health Care – ValleyCare now provides the Tri-Valley community with 24/7 access to stroke-trained neurologists.

Meeting a community need

“One of the main reasons for establishing the stroke program was that the community asked for it,” said Krishnamohan, who’s also a clinical assistant professor of neurosurgery and of neurology and neurological sciences at Stanford Medicine.

The ValleyCare Charitable Foundation, which recently merged with Stanford Medical Center Development, raised money from hundreds of community members to fund the program’s creation. Livermore residents Lynn and Joan Seppala matched donations.

“I'm proud of the fact that the community 100% backed us up to start this program,” Ferrer said, noting that the fundraising effort raised $1 million.

Developing the program took several months, from educating everyone in the hospital about strokes to designing a stroke-alert procedure. The goal was to speed things up and transform a sequential process into a parallel one, where personnel — such as a neurologist, a laboratory technician, a radiologist and a pharmacist — all would be notified at once about a new stroke case and know their roles.

All of these people are working together to provide care quickly, said Megan Akacsos, Stanford Health Care – ValleyCare’s stroke and neurology coordinator. The team effort extends to Stanford Health Care in Palo Alto, where neurologists can remotely examine patients in Pleasanton and help provide around-the-clock support.

Once Stanford Health Care – ValleyCare was certified as a primary stroke center, it was clear that the stroke program provided huge benefits.

“As soon as we became a Joint Commission-certified stroke center, the volume of stroke patients tripled” — an indication that emergency stroke patients were being taken elsewhere for treatment, said Ferrer, the first stroke program manager. “There was definitely a need in our community for a stroke center.”

Educating the community

The hospital began efforts to provide stroke education to community members when the ValleyCare Charitable Foundation was raising funds for the stroke program. At the time, Krishnamohan gave about two dozen lectures at retirement centers, churches and other places in the community about stroke awareness. Months later, he saw patients who’d recognized their stroke symptoms and knew to immediately call 911.

In acknowledgement of the stroke program’s success, Stanford Health Care – ValleyCare recently received the Stroke Gold Plus Quality Achievement Award from the American Heart Association and American Stroke Association. The award recognizes the hospital's commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines created from the latest scientific evidence.

The Stanford Health Care – ValleyCare stroke program continues to grow and develop. For example, the program’s team is starting a support group for outpatient stroke survivors to provide continual support for them and their families and caregivers.

“We want to make sure that our stroke survivors are not just surviving but that they’re thriving once they leave the hospital, as well,” Akacsos said.

Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.

2021 ISSUE 2

Unlocking the secrets of the brain

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