A 75-year-old longtime local resident was helping with a remodeling project in a Mount Vernon church last year when suddenly he couldn’t move his right side or utter a sound. Luckily, the church’s pastor was nearby and immediately called 911. With that call, this man was rushed to Skagit Valley Hospital in Mount Vernon, where staff had been alerted to his condition by emergency medical personnel in the field and were ready to care for him. He was quickly greeted by the ER stroke team and moved to the CT suite to make sure his brain did not show any signs of bleeding. Satisfied there was none, the ER team consulted with their telehealth partners at Swedish Neuroscience Institute in Seattle, administered brain-saving medication and transferred this man to Seattle where a clot blocking blood flow to a large part of his brain was removed.
A week later he was home, walking and back to his life.
The RN face of this program is Lisa Rodgers-Potter. She is an ED CNS who works to ensure the hospital stroke program is second to none. A nurse for more than 30 years, Lisa works with stroke patients and the nursing staff who care for them both in the ED and in Skagit Valley Hospital. Rodgers-Potter moves quickly between the nurses and doctors taking care of a patient with stroke symptoms, reminding them of the best placement for an IV, urging them get to CT quickly and ensuring the correct blood tubes are drawn. She works with nurses and local EMS crews to ensure that patients are receiving expert nursing care, all the while making sure that the patient and their family are included in the conversation.
Skagit Valley Hospital has been part of a telehealth stroke program since 2012, when Swedish Neuroscience Institute partnered with the Mount Vernon hospital, making it one of the first partnerships for telemedicine outside of the Swedish system. Patients with recent stroke symptoms trigger a well-oiled system that includes a quick trip to CT, labs and a physician exam. Once a stroke is identified, a neurologist at Swedish is contacted, either by video or by phone to review the case and make a decision on whether to give tPA, a medication that helps to dissolve clots. This whole process, from the time a patient comes in the ER door until the medication is started, can take as little as 35 minutes. “Our goal is to give the medication in less than 45 minutes,” Rodgers-Potter said. At that point, consultation with neurology determines whether the patient is admitted at Skagit Valley Hospital or takes a trip to Swedish Medical Center in Seattle for more definitive care, including possible retrieval of a clot.
Patients who are admitted at Skagit Valley Hospital are closely followed by Rodgers-Potter, Skagit Regional Health neurologists and hospitalists and by nursing staff in the inpatient units. Having the telemedicine relationship has allowed state-of-the-art care, including clot retrieval, within a short time frame. It means that appropriate patients go to Seattle and that more patients can stay in their own community, close to family and friends, while receiving excellent care. Not every patient is appropriate for tPA and Skagit Valley Hospital admits more than 200 people each year with stroke symptoms. Being part of a regional system of care improves outcomes for every patient and provides a resource for the community, from the EMS and the ER to outpatient rehab and a support group for families and caregivers.
Quality for the program is carefully measured, with each patient’s trip through the hospital carefully followed while they are here and after they leave. Once a month, stroke cases that were part of the telehealth program, are reviewed by Skagit Regional Health neurologists and RNs and their counterparts at Swedish. The telestroke equipment is used so that meetings are in real time and in a conversational tone that builds relationships, making it easy to pick up the phone whenever a question arises. Building these relationships widens the safety net for the region’s patients and the resources for hospital employees.
Meanwhile, just four days after his stroke, our 75-year-old patient was able to go home, regaining his strength and dexterity a little bit every day.