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Jason Thurman, M.D., left, stroke liaison in the ED, and Howard Kirshner, M.D., director of the Division of Stroke, work to care for patients in the stroke center. Photo by Dana Johnson

VUMC designated a primary stroke center

BY: JESSICA PASLEY

1/13/2006 - Vanderbilt University Medical Center recently received national designation as a primary stroke center, only the second such certification awarded in the state.

The Joint Commission of Accreditation of Healthcare Organizations (JCAHO) awards the Disease Specific Certification of Distinction to centers meeting stringent national guidelines that can provide the key services necessary for improving outcomes.

Stroke, a type of cardiovascular disease, is the leading cause of serious long-term disability and the third leading cause of death in the United States. Strokes occur when blood vessels carrying oxygen to the brain either become blocked or burst. Without the necessary oxygen, the brain begins to die.

The medical community has limited time when treating stroke patients. In fact, the clot-busting drug tPA must be administered within three hours of the onset of symptoms for optimal results. In many cases, the advancements in interventional procedures have extended the time frame to six hours.

“Historically, we didn't have a lot to offer someone once they suffered a stroke,” said Janice Smith, R.N., administrator for Neurosciences at Vanderbilt. “Now there are multiple treatment options; however the key remains early recognition and early intervention. Time is tissue.”

Vanderbilt has expanded its clinical and research faculty and bolstered the multidisciplinary initiative that brings together key resources under one umbrella to better treat patients with cerebral vascular disease.

Two cerebral endovascular surgeons, Robert Mericle, M.D., and Eric Eskioglu, M.D., along with interventional neuroradiologist Ted Larson, M.D., who directs Head and Neck Radiology and Interventional Neuroradiology, are available around the clock to perform emergency neuro-interventional therapies for acute stroke.

Vanderbilt's stroke center was established in 1998, preceded by clinical stroke research in 1992. Although the center has been around for some time, specific stroke certification was not available until recently. The official notification from the JCAHO was in December 2005.

The Emergency Department and the EMS teams that bring patients to the hospital are integral members of the stroke center team, Smith said. They are typically the first line of treatment.

“They have been instrumental in getting a rapid response for the stroke protocol,” she said. “Prompt intervention is critical and we often have little time to salvage the brain tissue. It really takes a collaborative effort to offer such a program,” said Smith.

“Around the country many states are requiring EMS systems to transport patients exhibiting signs of stroke to recognized stroke centers. Whether it's your brain or your heart, if the symptoms are not identified in a timely fashion and treatment started, it can be catastrophic.”

Howard Kirshner, M.D., director of the Division of Stroke, said Vanderbilt's program is the only service in the Midstate with dedicated stroke physicians, in-house residents on the stroke team, and around-the-clock availability of interventional neuroradiology and neurosurgery services.

It also boasts four stroke specialists, all certified in vascular neurology by the American Board of Psychiatry and Neurology, stroke fellows, and about seven clinical research protocols.

“Having this certification is important because the designation recognizes our accomplishment of standardized excellent stroke care for all of our stroke patients,” said Kirshner, vice chair of the Neurology Department. “We also have an active collaboration with basic neuroscience research related to stroke under Dr. Beth Ann McLaughlin (research assistant professor, Pharmacology Department). We also have available the Neurological Intensive Care Unit, which we share with Neurosurgery, the only specialized neurological ICU in Middle Tennessee.”

Currently, Robert Thurman, M.D., assistant director of the Emergency Medicine Residency Program, is the stroke center liaison in the ED. Vanderbilt already has assigned cardiovascular and stroke beds in the adult ED and is in the process of naming a chest pain/stroke center coordinator. The Medical Center also anticipates obtaining the comprehensive level for stroke centers — a distinction not yet offered.

“Criteria for this level of certification are being developed,” said Kirshner. “This would truly recognize the level of stroke care we provide. Comprehensive stroke certification would bring together all of the above elements, plus our stroke rehabilitation at Vanderbilt Stallworth Rehabilitation Hospital.”

In addition to providing evidence-based care, much of what the Vanderbilt program will focus on as a primary stroke center is education for staff, patients, EMS teams and the community at large about stroke, warning signs and treatment options.

“There are walking examples today of patients treated for stroke who do not suffer residual disabilities,” Smith said. “Treatment options are improving. Having our center is also an advantage for our inpatient units. Many surgical patients, who are predisposed to clot formation or are predisposed to stroke, will benefit from services we can provide through the stroke center.

“This national recognition provides additional support for our program, our commitment to evidence-based medicine, cutting-edge technology, highly trained staff, and our overall dedication to improving outcomes,” she said.

Stroke patients are housed on 6N and 5S, the acute care neuroscience unit and the neuro-intensive care unit respectively.

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