Telestroke program helps preserve quality of life
New technology enhances emergency department treatment
Women’s Heart Disease – often subtle but deadly
Telestroke program helps preserve quality of life
The emergency departments at Ministry Sacred Heart Hospital and Ministry Saint Mary’s Hospital are piloting an innovative program called Telestroke that provides expert neurology consultation for patients experiencing stroke symptoms.
Using state-of-the-art video telecommunications, Telestroke allows 24/7 access to the stroke neurologists at Ministry Saint Joseph’s Hospital in Marshfield, a Joint Commission certified primary stroke center.
A stroke, sometimes called a brain attack, occurs when a clot blocks the blood supply to or in the brain or when a blood vessel in the brain bursts. According to the Centers for Disease Control and Prevention, more than 795,000 people in the United States suffer a stroke annually, and almost 130,000 Americans are killed each year from stroke. Eighty-seven percent of all strokes are ischemic strokes, which occur when blood clots block the blood vessels to or in the brain.
Time is critical for effective intervention in an acute ischemic stroke, as approximately two million brain cells die every minute. The use of Telestroke will provide patients the benefit of a neurology consultation any time of day. To implement the program, emergency department rooms were transformed to accommodate the equipment required to support Telestroke.
Ministry Sacred Heart Hospital and Ministry Saint Mary’s Hospital worked closely with Ministry Saint Joseph’s to launch the program. “To support the effort, order sets were written and approved, and new protocols were developed,” said Emergency Department Medical Director, Mark Banas, DO, Ministry Medical Group. “The drug formulary was updated with medications that reflect best practice care for stroke patients, and educational sessions were given to ED providers, and nursing staff on using Telestroke.”
The Telestroke program uses Ministry Connect to initiate the consultation. “Despite being in a different location, the patient will be able to interact with the neuro-hospitalist at Ministry Saint Joseph’s as if they were in the same room, thanks to high-resolution cameras and audio equipment,” said Dr. Banas. “With assistance from the ED staff, the neuro-hospitalist can perform an exam to assess the patient and rank the severity of symptoms. In addition, they will have access to lab results, past medical and medication history, and will be able to view the patient’s CT scan. This will help them collaborate with the ED provider and decide on treatment options for the patient.”
The Telestroke program will be expanding throughout the Ministry system and central and northern Wisconsin emergency departments over the course of the next year.
Stroke is the fourth leading cause of death, and a leading cause of long-term disability. “This is an exciting opportunity for our hospitals to positively impact the health of our communities,” added Dr. Banas.
Symptoms of a stroke include: sudden numbness or weakness of the face, arm, or leg, especially on one side of the body, sudden confusion, trouble speaking or understanding, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, or sudden severe headache with no known cause. If you suffer from any of these symptoms, seek medical care immediately.
New technology enhances emergency department treatment
Ministry Our Lady of Victory Hospital (MOLVH) has enhanced its emergency department with MEDHOST™, a state-of-the-art emergency department information system. Using touch screen technology and a large flat screen monitor, MEDHOST makes it easier for MOLVH staff to care for their patients, while allowing quick access to important medical information – all of which can save time in an environment where lost seconds can mean lives lost.
The system was specifically developed to work in emergent situations where ease, speed and access to information is crucial. The system uses advanced technologies including voice recognition, touch screens, and medical and patient information databases. It is integrated with other information systems such as laboratory and radiology, which speeds getting critical results back to the emergency department.
Barb LatoBarb Lato, Ministry Our Lady of Victory inpatient nurse manager, believes that the benefits of using an electronic system over the previous paper-based system are substantial. She was also impressed by how the organization prepared for the change. “Our nursing, admitting and diagnostic services staff did an excellent job of preparing for this change, attending comprehensive education and independently completing sample patient modules. Without this commitment to the extended time needed for training we would not have had such a successful transition.”
For some patients a visit to the emergency department continues with a hospital admission or a referral for a follow-up appointment. In these cases, Toni Smith, emergency department nurse manager, noted, “We are very excited about moving the documentation of care provided in our emergency department and urgent care to the electronic medical record that is now available to all of our Ministry Medical Group providers and other specialists who provide care to our patients. This will assure good continuity of care when patients follow-up from their emergency room or urgent care visit."
The system was activated at MOLVH in July after several months of preparation, which included significant investments in computer software and equipment, remodeling, training, and streamlining work flow processes. Cynthia Eichman, Ministry Our Lady of Victory Hospital President, commented, “Toni Smith has done an excellent job working with the combined Ministry and MEDHOST Project Team to ensure this transition went smoothly. Our ER physicians were also engaged, very supportive and participated in the needed education to provide seamless care with the transition from paper to electronic."
MEDHOST is dedicated to advancing healthcare IT by developing user-friendly software solutions that improve hospital-wide operations, emergency department care, patient flow, surgery and anesthesia care cycles, financial performance and patient care, safety and satisfaction. Its intuitive, easy-to-use solutions align with end-user workflow. MEDHOST, headquartered in Plano, Texas, is part of HealthTech, a health information technology company with a family of brands that also includes Healthcare Management Systems (HMS) and Patient Logic. Connect with MEDHOST on Twitter, Facebook and LinkedIn.
Women’s Heart Disease – often subtle but deadly
You’ve undoubtedly heard of the widow maker. It’s a nickname for an aggressive heart attack caused by a blockage of the left main coronary artery. Striking swiftly and surely, the widow maker took the life of broadcast journalist Tim Russert while he was sitting in his NBC office.
As a woman, the prospect of suddenly losing a husband is frightening, but what you are conveniently ignoring is that this type of massive heart attack makes widowers as well as widows.
"Popular stereotypes tell us that heart disease is a man’s worry," said Thomas Tuttle, MD, internal medicine physician with Ministry Medical Group in Stanley. "Unfortunately the facts tell us otherwise. Heart disease is the number one killer of both men and women in this country."
More than half of the fatal heart attacks each year happen to women (455,000 vs. 410,000 for men). And at a time when the rate of heart attack mortality in men is declining, the death rate for women continues to climb.
One reason for the popular stereotype is that, because of hormonal differences, heart disease tends to strike women after menopause, an average of 10 years later than it does men. Nevertheless, even young women do suffer fatal heart attacks.
There is another reason why people don’t think as much about heart disease in women. Dr. Tuttle explains, "In the past, most heart disease research was conducted using mostly male subjects. This was done mainly to eliminate the risk of giving experimental drugs to women who could be pregnant or risk skewing the data because of hormonal changes that were related to the menstrual cycle. As a result, much of what is known about heart disease applies mainly to males, and recent research has demonstrated important gender differences in the way heart disease presents itself."
Dr. Tuttle says that there are many things women should know about heart disease and their risks.
What are the risk factors of heart attack?
While modifiable risk factors are generally the same for men and women, there are gender differences in the way these are expressed.
Smoking, for example, increases the relative risk for women by at least 25 percent compared to men, according to one recent study using pooled data from 2.4 million subjects.
Obesity is a universal risk factor, but for a woman being even a little overweight can dramatically increase the risk of a heart attack. A woman 5 foot 4 inches tall who weighs 140 pounds, for example, has a risk 30 percent greater than a woman the same height weighing 125 pounds.
Obese women have a nine-fold increased risk of diabetes, and diabetes increases a female’s risk of coronary heart disease three to seven times compared to two to three times for a male.
Because of hormonal differences, women tend to have higher HDL (good) cholesterol levels than men until menopause. By age 60, HDL levels start to drop in women, however, and women’s LDL levels tend to be higher on average than those of males.
In addition, women tend to have higher levels of CRP (c-reactive protein), a marker of inflammation. And high CRP is a greater risk factor for women than for men.
Know the symptoms of heart attack
Angina (or chest pain) is the most readily recognized symptom of a heart attack, but chest pain in women often does not meet the typical definition and, as a result, often gets missed. This may happen because women are less likely than men to have completely obstructed coronary arteries.
According to data from WISE (Women’s Ischemia Syndrome Evaluation), women are more likely to have abnormal function of smaller blood vessels feeding the main coronary arteries. While these may not cause the crushing chest pain that patients are taught to look for, the heart attacks they cause are no less fatal.
According to recent studies, many women experience early prodromal symptoms more than a month before a heart attack–unusual fatigue, sleep disturbance, shortness of breath, indigestion, anxiety and either non-specific chest discomfort or no symptoms at all.
When the early signs appear, there is plenty of time to intervene. Underestimating the gender-related risk, many women, and even their doctors, fail to take note. About 52 percent of female heart attack victims die on their way to the hospital (compared to 42 percent of male victims).
How can you protect yourself?
According to Dr. Tuttle, "The first step is to understand your risk–as a woman and as an individual. The next is to take action as early as possible: don’t smoke, exercise, control your weight and watch your blood pressure and cholesterol. Listen to your body for signs."
Coronary Heart Disease: Are We Winning the Battle?
Coronary heart disease is still the number one killer of American men and women. But heart attacks are decreasing, and people who have an attack are more likely to survive–continuing a trend that started many years ago and is gathering momentum.
The good news in the 1970s and 1980s resulted from ground-breaking events–the development and use of coronary artery bypass graft surgery and balloon angioplasty; the Framingham Heart Study and better understanding of the role of diet and exercise in the prevention of heart disease.
The results of these and continuing advances in treatment are now beginning to show up. Data from three million members of Kaiser Permanente Northern California health system found a 24 percent decline in the number of heart attacks and a similar decrease in heart attack deaths from 1999 through 2008.
The most serious type of heart attack is an ST elevation heart attack. This refers to a finding on an electrocardiogram, wherein the trace in the ST segment is abnormally high. In the Kaiser study, for ST-elevation heart attacks, the drop was 62 percent. Those results were echoed by a Canadian study finding a 30 percent decrease in heart attack deaths from 1994 through 2004.
Authors of the Kaiser Permanente study stressed the importance of adopting healthier lifestyles on a large scale. During the study period, Kaiser patients were less likely to smoke and they succeeded in lowering their average blood pressure and cholesterol.
According to Thomas Tuttle, MD, family physician with Ministry Medical Group in Stanley, "We know the risk imposed by tobacco, and the decline in cigarette smoking is undoubtedly based on increased acceptance of that fact. Less widely known is research showing that exposure to second-hand smoke creates a cardiovascular risk nearly as great as that of active smoking. Several studies have documented dramatic declines in heart attacks following passage of laws restricting smoking in public places."
The American diet has been changing gradually over the past four decades. The early emphasis on strictly low-fat eating has been modified somewhat, now focusing on replacing unhealthy saturated and trans fats with healthy ones (monounsaturated oils, nuts, fatty fish). Through the Mediterranean diet and similar plans, it’s possible to pursue pleasurable eating and good health at the same time.
Americans still consume too many calories and too much sugar (much of it in the form of soft drinks). Dr. Tuttle said, "Obesity, particularly among children and adolescents, continues at an epidemic pace. Obesity leads to diabetes, and diabetes increases the risk of heart disease.
Considering these facts, the progress found in the study is heartening...although clearly the battle is far from over."
The American Heart Association’s guidelines for regular exercise are also well known. Those who follow the guidelines have a way of controlling their weight, blood pressure and cholesterol through activities that strengthen the heart and blood vessels.
In addition to making lifestyle changes, Kaiser Permanente patients were increasingly likely over the course of the study to use prescribed medications such as aspirin, anticoagulants and blood pressure and cholesterol-lowering medications.
As the number of heart attacks has declined, so has the rate of heart attack deaths–from 10.5 percent within 30 days of an attack in 1999 to 7.8 percent in 2008. In 1999, according to the Kaiser study, 47 percent of heart attacks were the more serious type, but by 2008, this number had fallen to 23 percent. One reason for this decline was prevention; another was undoubtedly better detection of less serious attacks, prompting more aggressive attention to risk factors.
In a non-ST-segment elevation heart attack (the less serious kind), movement of blood is slow but only partially blocked. This can be treated with the use of clot-dissolving medications. The more severe ST-segment elevation heart attack involves a complete blockage of a coronary artery, and instant action must be taken to prevent death or serious damage to the heart muscle. Today, this is most commonly achieved through balloon angioplasty or coronary artery bypass graft surgery.
Having proper facilities, equipment and personnel is crucial, of course. But so is timing. Reducing the "door-to-balloon" time has been a major priority of hospitals; this is the time that elapses from the moment the patient enters the door of the emergency room until life-saving treatment is administered.
Dr. Tuttle concludes, "The battle against heart disease is being waged on many fronts. Prevention–through lifestyle changes and medication–is working. And when heart attacks occur, doctors are prepared to take definitive action."