By Patty Pensa, South Florida Sun-Sentinel
Jul. 7–View Detailed Version
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As stroke care advances, hospitals are lining up to create centers to treat these “brain attacks” with as much urgency as they treat trauma patients.
Hospitals are propelled by a 2004 state law that sends ambulances to stroke centers even if another hospital is closer. Florida leads the nation in the number of stroke centers because of the law, the state’s large population and older demographic. Broward County has 11, second only to Pinellas County’s 12.
But not all stroke centers are the same, and it can be hard for patients to know the differences. Some hospitals don’t have neurosurgeons to handle complications or bleeding strokes. Most are primary stroke centers, which offer baseline care. A few are comprehensive centers with cutting-edge treatment, but patients aren’t always transferred to them.
Doctors agree centers are a better approach to stroke care, but some question how many are needed.
“The more hospitals that are actually able to qualify as stroke centers, the better off it is for the patient,” said Dr. Nabil El Sanadi, chief of emergency medicine for Broward Health, “because every second counts.”
About 780,000 Americans have strokes each year, and the disease remains the nation’s No. 3 killer after heart disease and cancer, according to the American Stroke Association.
Dr. Jonathan Harris would have preferred only four stroke centers in Broward. But competition prevailed. Fewer centers would have resulted in higher patient volumes, more experienced care and reliable specialty coverage.
“As soon as you had two or three, everyone wanted to be a stroke center,” said Harris, stroke center medical director at North Broward Medical Center in Deerfield Beach. “Frankly, I was a little disappointed.”
Suffering a stroke used to mean paralysis. Little could be done until the clot-busting drug tPA was approved for strokes in 1996. Outcomes hinge on how fast patients seek help: Nine out of 10 stroke sufferers are ineligible for tPA treatment. But combined with surgical advances, some stroke patients today need little rehabilitation.
North Broward in 2005 became the county’s first stroke center. A year later, it became the first of three comprehensive centers in the county. A comprehensive stroke centers is a step up from primary center. It has a neuro-interventional radiologist who uses a catheter and tools to remove blood clots. Such procedures can be done up to eight hours after the onset of a stroke, compared with a three-hour window for tPA.
The Joint Commission, which accredits hospitals, launched stroke certification in 2003. Stroke care is largely about standards. How long does it take to get an image of the brain? How much longer to read that image? No more than 45 minutes combined, according to the standards. Lab tests must be done in that time, too.
“You’re making a decision on how that patient is going to be treated the minute they hit the door,” said Jean Range, an executive director at the Joint Commission.
About 100 hospitals in the state are stroke centers, and Range expects that number to grow. Imperial Point Hospital, for example, plans to be certified in about a year.
The Fort Lauderdale hospital experienced a bump in emergency visits, admissions and surgeries since nearby North Ridge Medical Center closed this year. With an older demographic, the hospital wants to serve its growing patient base, said Calvin Glidewell, chief executive officer.
“We want to make sure we’re prepared for the type of patients we might receive,” he said. “We’d like to get to the point where EMS are bringing stroke patients to Imperial Point.”
If hospitals don’t join the trend, they’ll not only lose patients but will open themselves up to liability. Dr. El Sanadi, of Broward Health, compared it to a trauma patient going to a hospital that isn’t a trauma center. That patient would be a “hot potato” and the hospital would be better off transferring the patient to a certified stroke center.
Hospitals routinely handled stroke patients before the concept of a stroke center developed and state law dictated patients would go there. Before the mid-1990s, rehabilitation was the main treatment. When tPA — a drug originally used for heart attack patients — was approved for stroke, it opened up a world of possibility for stroke sufferers.
Its main drawback: Nine of 10 stroke patients can’t get the drug because they don’t recognize their symptoms early enough.
At Cleveland Clinic in Weston, about 13 percent of stroke patients qualify for tPA, said Dr. Efrain Salgado, the hospital’s stroke center director. The average nationwide is 3 percent to 4 percent of patients, doctors say.
“The Achilles’ heel is patients don’t get to the ER on time,” said Salgado, “and that’s really a shame.”
Patty Pensa can be reached at [email protected] or 561-243-6609.
Find one near you Search an interactive map of South Florida stroke centers at Sun-Sentinel.com/strokecentermap
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