Yuma Hospital with High Retiree Winter Population Improves Stroke Program

Jul 11, 2017

Yuma is a popular destination for snowbirds, aging retirees who come to enjoy warm weather during the winter months.  Close to 100 thousand extra residents put a strain on the region’s only hospital, Yuma Regional Medical Center.  To meet the needs of this population, YRMC must be prepared to treat stroke—the fifth leading cause of death in the U.S.  Maya Springhawk Robnett of the Arizona Science Desk reports on the hospital’s efforts to become a Primary Stroke Center…

Stroke occurs when a blood clot blocks flow to a part of the brain, causing brain tissue to die.  The aftereffects include paralysis, weakness, impaired vision or speech, and death.

For medical providers, diagnosis and treatment of stroke victims is a race against the clock.  It begins in the Emergency Department.

Every minute that we delay, one-point-nine million brain-cells die.

“So this is where the ambulances will pull up,” Micaela Prevatke, a nurse and Yuma Regional Medical Center’s Stroke Program Coordinator, gestured to the Emergency Department entrance.  She said from the moment a patient comes in, the stroke team is in action.  “So we all at once start talking to the medics, try to get the story,” she continued. “What’s going on? Get blood drawn…”

Dr. Greg Baker, a neurologist and the Stroke & Neurology Director at YRMC, further illustrated the scenario. “While we’re heading down, often the stroke team starts asking all the questions that need to be asked,” he explained. “We try getting as much the information, including the exam part of it, on the way.   So, all that’s happening as we’re heading towards CT scan because every second matters.”

CT scans help doctors determine if there is an issue, such as bleeding in the brain, that would rule out use of a particular medicine. 

“It’s a medication called Alteplase,” YRMC neurologist Dr. Sarah Sullivan explained. “It’s a very strong medication which breaks up blood clots.  It’s been around for decades but statistics show that patients will definitely do better for receiving it in acute stroke.  It actually remains the only FDA-approved medication for patients that are having acute stroke.”

Alteplase, which is also called TPA, can stop a stroke in its tracks but the team only has a four-and-a-half-hour window to administer the medication from the time symptoms begin, so establishing the timeline is imperative.

“The time last known well—that’s a phrase we use often,” Dr. Sullivan said. “And patients that have family members with them that can give us a really clear and concise story about when these symptoms started or when they saw the patient last acting like themselves really helps us so much.”

Nurse and Program Coordinator Michaela Prevatke said there’s also another pressing reason this team has learned to walk and talk at the same time: “Every minute that we delay, one-point-nine million brain-cells die.”

After the CT scan, the patient is taken to the trauma bay, where the hospital has implemented more stroke care improvements.  If a neurologist isn’t in-house, the patient still will get assessed.  A large television screen hangs above the sliding glass doors, facing the patient bed.   

“Tele-stroke is when a neurologist is able to come on to the cameras, onto video, in the room with the patient, and assess them remotely from wherever they’re at,” Prevatke explained.

This gives neurologists another option to assess patients.  But if they determine a patient doesn’t qualify for TPA due to brain bleeding, drug interaction, or another concern, doctors much find another treatment plan.

In the elevator to the hospital’s recently renovated helipad, Dr. Greg Baker said sometimes the best treatment is available somewhere else.

“Up to six hours, there’s [sic] procedures that can be done where they can go in, grab the blood-clot, and pull it out,” Baker said. “And that’s up to six hours.  But we don’t do that here.  They only do that in Phoenix.  So that’s one of the reasons we might send somebody out.”

The stroke team’s eventual goal is to assess each patient and administer Alteplase or to determine if the patient should be sent out in less than 20 minutes.  For now, they’re shooting for less than 45.  The hospital anticipates being certified as a Primary Stroke Center by the Joint Commission in 2018.