For the last four years, Alpena Regional Medical Center has been participating in a University of Michigan study to develop best practices for stroke care. Since enrolling in the INcreasing Stroke Treatment through INterventional Change Tactics study, ARMC doctors and nurses have worked to streamline patient treatment procedures and have increased the time in which they're able to treat patients.
The study specifically focuses on treatment of acute ischemic stroke - a type of stroke where a blockage obstructs a blood vessel in the brain - and gives the hospital access to a 24-hour stroke consult at U-M. Once symptoms of the stroke appear, there is only a three-hour window for doctors to administer intravenous tPA, a clot-busting medicine, that reverses the effects of the stroke.
"The goal is from the time they come to the hospital till the time the drug is given - nationwide - to try to get them in in 60 minutes," Mary Jo Skiba, project manager for quality and research, said. "We've treated (patients) under a half hour."
Nancy Niergarth, RN, said the study has changed how the hospital responds as far as emergency medical service providers and in the emergency department to anyone who is having a stroke. Area EMS providers are trained to recognize the signs of a stroke, start IVs and perform EKGs while the patient is en route to the hospital. Once the patient arrives at the hospital, they are met at the door and are taken for CAT scans and bloodwork before tPA can be administered.
ARMC is one of 24 randomly selected Michigan hospitals participating in the study, which is supported by the National Institutes of Health. INSTINCT is a clinical trial testing methods to increase stroke treatment and is led by Phillip A. Scott, MD, associate professor of emergency medicine at the University of Michigan.
Scott has been to ARMC multiple times to interview the emergency staff, provide education to physicians on stroke care and treatment and has conducted mock stroke codes in the emergency department, Skiba said.
She said ARMC is twice as fast to respond to patient strokes as some of the hospitals in the study. Chuck Sherwin, vice president of business development, said they're finding ARMC is beating some of the state and national averages and is recognized as one of the best in the state related to stroke care. In June 2009, the hospital received awards for the fastest average stroke tPA treatment time and the best data reporting performance during the INSTINCT trial's stroke champions meeting in Ann Arbor.
According to Sherwin, because Alpena is an older community with higher incidents of obesity, diabetes, cardiovascular disease and smoking, there is a higher risk for stroke. Skiba said there will be incidents of more strokes nationwide because the average population is aging.
If the study receives further funding ARMC will continue participating in the study for another four years.
"Regardless of the funding, it certainly has changed how we respond as a hospital, as a department," Niergarth said. "We will continue to respond more quickly, more smoothly, so that won't change."
Crystal Nelson can be reached via e-mail at cnelson@thealpenanews.com or by phone at 358-5693.