UNC Hospitals became the first hospital in the Southeast to receive the Joint Commission Advanced Certification as a Comprehensive Stroke Center in 2012, solidifying strong leadership in stroke care. The excellence and quality that defines the UNC Hospitals Comprehensive Stroke Center stems from its people—a team of physicians, nurses, radiologists, anesthesiologists, technicians and others who have committed to caring for acute stroke patients. For these patients, the trajectory of their lives can be changed if the stroke team can remove a blood clot soon after the onset of stroke symptoms. A matter of hours can define whether a patient is discharged to a rehab center or discharged home and back to work in a few days.
It is the difference made in a matter of hours that has led each member of the Stroke Center team to commit that, when on call, no matter the day of the week or hour of the day, they will drop everything and care for a person experiencing an acute stroke. For Dr. David Huang, Director of the Comprehensive Stroke Center, this means responding in less than five minutes to a call about an acute stroke patient, simultaneously reviewing CT scans, and getting to UNC Hospitals within 10 minutes of the initial notification. He has two computers at home (one is a backup in case the first happens to fail) and a computer in his car.
Dr. William Powers, professor in the Department of Neurology, is a member of the Comprehensive Stroke Center team. During his tenure at UNC, 10 years of which he served as chair of the Department of Neurology, Dr. Powers has seen stroke care improve tremendously. In the mid-1990s, an intravenous injection of the drug tPA had changed the landscape of acute stroke treatment. Administered within 3 hours of onset of an acute stroke, tPA dissolves the clot and improves blood flow to the part of the brain being deprived of blood. In 2008, tPA showed potential for treatment extending to four and a half hours out, and UNC Hospitals set up its system for physicians to rapidly identify and assess patients so that those experiencing an acute stroke could receive the life-changing injection within this window. Then, in 2014, the landscape of stroke care changed dramatically. That fall, a method of physically grabbing the clot and removing it from the brain was demonstrated to be effective. This method increased the window of time in which an acute stroke could be treated from four hours to six hours. Dr. Powers reflects, “This changed everything.”
While the advent of the new clot removal did change everything, it also meant coordinating a team of experts—ER doctors, radiologists, anesthesiologists, neurologists, nurses, technicians and more—each of whom plays a critical role in assessing and treating acute stroke patients. And, before this, air care or an on-the-ground transfer system had to get patients to UNC Hospitals. This is when Dr. Huang began working with a large team of critical players to reduce the time between first notice of a patient in need of care to the patient being prepped and ready for the clot removal procedure. Because of the work of Dr. Huang and his team, an acute stroke patient will be through the CT scanner and in the angio suite for treatment within 40 minutes or less after landing on the UNC Hospitals helicopter pad or arriving by ambulance.
Dr. Powers believes that an acute stroke patient “will get no better care any place in the world.” He describes a recent patient who came in totally paralyzed on one side and unable to speak and went home 4-5 days later nearly back to his old self. This level of care is a result of what Dr. Huang describes as “a culture in which everyone is moving towards excellence, and excellence means integrated care.” This means that if a patient needs to be at the UNC Hospitals Comprehensive Stroke Center, they will get them in—this team is not in the business of denying an acute stroke patient, even when there are officially no beds.
Dr. Huang’s vision for the Stroke Center is that a farmer Duplin County has the same access to state-of-the art care as a well-funded retiree in Chapel Hill. Working towards this vision requires a pipeline of physicians and nurses ready to join the demanding UNC Stroke Center team. Dr. Huang adds that stroke physicians want to be in an environment in which they know they will have the resources they need to succeed. If he can offer these resources to current and prospective team members, he can build a larger team with a stronger infrastructure that can care for even more patients, because—despite everyone’s best efforts to prevent them—strokes still happen down the street as well as several counties over.
Dr. Powers never thought the day would come when we could say, “We cured this stroke.” He shares that because of the team at the UNC Comprehensive Stroke Center, “we’ve done that.”
For more information on how to support the UNC Comprehensive Stroke Center, please contact Aron Johnson, Director of Development, at 919-843-9902 or aron_johnson@med.unc.edu.
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