Georgia Coverdell Acute Stroke Registry quarterly newsletter [Summer 2012]

Coverdell Partners:
Georgia Department of Public Health (DPH)
Emory University School of Medicine
Georgia Medical Care Foundation (GMCF)
American Stroke Association (ASA)
Georgia Hospital Association (GHA)
If you have anything you would like included in an
upcoming newsletter or have
achieved recent recognition in the
area of stroke, contact:
Kerrie Krompf
kkrompf@emory.edu
or
404-616-8741

Georgia Coverdell Acute Stroke
Registry Quarterly Newsletter

SUMMER 2012

Georgia Coverdell Receives Continued Funding
GCASR is excited to announce that CDC has selected us for continued funding for the next grant cycle through June 2015. In this three-year time period, we will continue to focus on acute care quality improvement for stroke, as well as embark on a new journey: greater collaboration with EMS. This is part of a new focus on the broader Stroke System of Care from the federal level, with the intent of smoothing the transitions of care for stroke patients. This new component could not come at a better time for Georgia as many of our hospitals are already beginning to focus on bridging the gap between EMS and the ED.
We are thrilled to begin working more actively in this area, and know that our stroke patients will only benefit from greater collaboration between EMS and the ED. Planned QI activities include webinars and workshops with subject matter experts, and a new standardized form for providing information on stroke patients from the hospitals back to EMS. As always, the Coverdell staff is here to support you in your work during this new phase, and to help you surmount any challenges that you may encounter in your daily work. We will also be working closely with the Office of EMS and Trauma at the Georgia Department of Public Health on these new activities, as well as regional and local EMS personnel.
We welcome your input and feedback as we embark on this new phase of work, for it is only through you that we can truly move forward to improve stroke care for all Georgians. Thank you for your continued efforts and we hope to see all of you at the August 16th Coverdell Workshop which will focus on "The Next Phase of Coverdell: Collaboration with EMS" at Northeast Georgia Medical Center!
Submitted by: Lydia Clarkson, PI, GCASR
Georgia Stroke Professional Alliance (GA-SPA)
The next GA-SPA meeting is scheduled for Wednesday, August 15th from 10AM-3PM at the Wellstar Development Center, 2000 South Park Place, Atlanta. The agenda will consist of Attorney Stephen Levinson discussing the non-profit status of the GA SPA. There will be a presentation on "Endovascular Stroke Therapy: Why, How, and When" by Dr. Raul Nogueira as well as a presentation by Dr. Gwynn. In addition, Pat Clark will present on writing and publishing articles. The GA-SPA currently has nearly 240 members. If you would like to become a member, contact Kerrie Krompf at kkrompf@emory.edu or 770-380-8998.
GA SPA had a great turnout at the Gwinnett Braves "Strike Out Stroke" night on May 24th. Thank you to those that volunteered to help out.

Recognition of Coverdell Hospital Stroke Month Activities - May 2012
Atlanta Medical Center
Atlanta Medical Center started the May Stroke Month activities by providing stroke education and prevention strategies to four local Senior High Rise Centers as part of their Healthy Living Series. Community outreach continued with Dr. Mishu, the Stroke Medical Director, and the Stroke Coordinator sharing information to the employees of Georgia Pacific at their monthly Lunch/Learn regarding stroke prevention.
There was a lunch and learn provided for the AMC employees focusing on Stroke Prevention and Improving Brain Health. To ensure that an ongoing prevention message would be provided to the staff at AMC a new program was implemented to share Healthy Lifestyles at monthly staff meetings. The kickoff for the program provided the staff a Stroke & Cardiac Risk Assessment tool and Stroke Risk Scorecard to complete and use as a guide for healthy lifestyle management. The monthly ASLS class continues to support stroke education to the staff at AMC. The May ASLS class included nursing students from Clayton State and Mercer Schools of Nursing.
The Emergency Department provided an EMS appreciation cookout which featured updated information for prehospital stroke management. During the cookout we took the opportunity to recognize the First AMC EMS Crew of the Quarter for their outstanding service to the community.
There were several health fair events at churches and community associations that staff members participated in. FAST cards were shared at many of the events listed above along with a Stroke Risk Assessment tool and a plan on how to modify risk factors. It was an extremely busy month and it doesn't stop in May, education and outreach continues throughout the year!
In addition, AMC believes EMS is key in recognizing acute stroke patients in the community and being sure they are immediately transported to a Primary Stroke Center and Stroke-Ready facilities. In an effort to thank them for their efforts, the staff at AMC recognized them during March Madness with "EMS Madness." They were provided a tote bag with an AMC t-shirt, pen, and a one page newsletter describing the Stroke and Trauma programs at AMC. This was a small token of appreciation given to them for what they do every day!
Emory Midtown
Emory Midtown had a great Community Stroke Fair on May 22, 2012. In addition to giving out Stroke Education materials, they had two neurologists onsite, which was wonderful, especially for their hypertensive guests who received on-the-spot advice. Blood pressure screenings were administered which led to a couple of visitors going to the ED for treatment.
They saw over 200 visitors in a 4 hour period. Some of their guests were Emory employees who did not know they had hypertension. It was enlightening and educational for staff and visitors. The visitors commented that their meeting with the neurologists was a positive influence in getting treatment.
Thanks Drs. Kenton and Wright. You made a big difference in the lives of many !!!!
Emory University Hospital
Emory University Hospital participated in two Stroke Events at the end of April. Health screenings, stroke education presentations, and educational materials were provided to participants on April 28, 2012 at New Covenant Church of God in McDonough, GA, and April 29, 2012 at Zoe Baptist Church in Conley, GA. Thanks to Emory nurses Susan Johannes & Kimberly Reeves for inviting the Neuro Patient Family Education Committee & Emory Staff to participate in their church's Community Health Fair. Emory collaborated with Clayton State University Nurses Students, Piedmont Henry Medical Center staff and all the Church volunteers who helped with education & screening. Emory University Hospital had their annual Stroke Health Fair on May 31st.

Floyd Medical Center
Floyd Medical Center has really worked tirelessly for outreach to the community for Stroke Awareness during the month of May. All differing specialties have helped us to conduct health fairs; we have gone to senior living centers, local recreation departments and churches to get out the message of "Time Lost Is Brain Lost."
To kick off Stroke Month: we started in April on the 30th at the YMCA with a full agenda of stroke screenings to include B/P checks, blood glucose checks, EKG's, and cholesterol levels. Other departments such as the Breast Center, Bariatrics, Physical Therapy, Diabetes Services, Family Practice, Sleep Lab, GI Lab and Rehab Services came to assist us to get the message of knowledge into the community. On May 2 we in-serviced at the Thornton Center with a PowerPoint presentation on different kinds of strokes and actions taken, and on May 8th we visited Horizon Bay retirement residents with giveaways and question/answer sessions. On May 10th we revisited Horizon Bay and in-serviced the staff with signs to look for in their patients and the importance of FAST action. On May 12 we attended Sunday Service at Thankful Baptist Church and presented the push for education in the women and African American population, discussing the rising need for education and risk to this group of individuals. On May 15th we visited the Renaissance Marquis Retirement center in-servicing a group of approximately 40 staff members of the importance of signs and symptoms of stroke, acting fast, and importance of post stroke compliance with medication and follow-ups with physicians. On May 17th the African American AARP group had invited us to speak on Stroke awareness. This is the 3rd year we have spoken to this group and they fed us well. Door prizes and giveaways were provided. On May 19th New Armuchee Baptist Church had a community health fair and we were asked to participate. We conducted our stroke screening, B/P checks, EKGs, blood glucose and cholesterol checks. On June 2nd Thankful Baptist Church had a power point reminder for the last 4 weeks during service, which led up to the Community Health initiative we conducted. Once again we did all the screenings and testing as previously stated. There were also prize drawings and giveaways.
We have planned a few more screenings for later in the year but this year we have blanketed the community to encourage knowledge of what to look for, what you can and can't change, and how time can affect your recovery. Our hope is for everyone to know about changes they can make. And if this message has been received by even one person and affected their health positively, we know we have been successful in our message.
As we concluded Stroke Awareness Month, we remember that there always opportunities to learn more and be an advocate for a healthy brain. Our Stroke Survivor Group called the "STARS" meets monthly, the last Wednesday of the month at 4pm in the private dining room of Floyd Medical Center. If you or a loved one has had a stroke, feel free to attend and help to grow our program. (SURVIVORS THAT ARE RECOVERING SUCCESSFULLY)
Grady Health System
The Grady Health System was involved in several community activities in May. We had our physicians speak at different venues such as Home Depot. Stroke screenings and education have been provided at Grady Hospital, community health centers and the Department of Transportation. In partnership with the American Heart and Stroke Association, Grady also had a presence at the Atlanta Hawks Game at Phillips Arena, Discover Mills, and Lenox Malls. Billboards featuring former stroke patients have been erected at various sites around the city. Additionally, Grady started a monthly stroke support group. Lastly, we have had two hospital-wide education sessions during stroke month related to ethical decisions and mobility in the ICU.
Gwinnett Medical Center
Gwinnett Medical Center celebrated the awards we have earned over the years and the staff that make it happen. We appreciated the EMS, who bring the stroke patients to our facilities, and the Emergency Department nurses that quickly recognize and triage our stroke patients. We commended our imaging staff for never making us wait on CT scans, and the radiologists, who rapidly report findings to the Emergency Medicine physicians. Laboratory technicians are prized for expediting our lab results. We thanked our terrific physicians that make all the important treatment decisions for our patients. Our stroke units were treasured for their excellent care of our stroke patients, and of course the rehabilitation personnel that get our stroke folks on the way to functional recovery. Even our marketing department was valued for helping us arrange and provide community stroke education. To celebrate all of their efforts, we had celebrations on each campus with a quick stroke survey, prizes, giveaways, food, and fun.
Education was also part of the Stroke Month theme at Gwinnett Medical Center. We provided a stroke booth May 12th during GMC night at the Gwinnett Braves game. Mock Stroke Codes were conducted during the Emergency Department skills days. Physician and clinical staff were educated by one of our neurologists on stroke mimics, and community education was provided to an assisted living facility and a heart surgery survivor support group. Marketing posted stroke awareness adds in our local paper to encourage better recognition of stroke symptoms and response in our own community.

Northeast Georgia Medical Center
We started Stroke Month a little early this year on April 25th with the "Link By Link" program, sponsored by Genentech. There were 47 EMTs, nurses, physician, and therapists from 11 nearby counties in attendance with great dialogue and participation. Evaluations were excellent.
We also partnered with Heart Failure for a mini-health fair outside the cafeteria on May 29. We offered literature, door prizes, and heart-healthy recipes. Over 200 employees, visitors, and volunteers attended. We've had this fair in years past, but the attendance was the best ever this year. In fact, we had to end a little early because we ran out of materials! On the same day, tent cards were delivered with the patient's lunch and dinner trays with the symptoms of stroke on one side, and the F.A.S.T. test on the other.
"Heart Healthy Recipe Challenge" employees were invited to submit their favorite hearthealthy recipes to be posted on the intranet. This was the first time we offered the recipe challenge and it was VERY popular with staff. Recipes had to be low calorie, low fat, and low sodium. 28 recipes were submitted, including Pork Chops in Country Onion Gravy, Chicken and Melon Stuffed Shells, Honey-Soy Broiled Salmon, Southern Shrimp and Grits, Tropical Island Fluff, Athenian Fish with Cucumbers and Tomatoes, Grape Salad, Ginger-Orange Shrimp, Autumn Pot Roast with Horseradish, and Awesome Quick Paella. The name of a contributor was drawn at random for a gift certificate to a local restaurant.
We also participated in the "Strike Out Stroke" night at the Gwinnett Braves game with the Georgia Stroke Professional Alliance on May 24th.
Some of the month-long activities included: Pharmacy Bag Stuffers stuffers were designed to fit easily inside a prescription
bag. They were printed with symptoms of stroke and the F.A.S.T. test, English on
one side and Spanish on the other. Almost 15,000 were delivered to independent
pharmacies in Hall, Lumpkin, White, Habersham, and Dawson counties. They placed
a flyer in the bag of each prescription filled in the month of May.
Weekly stroke informational articles appeared in the hospital newsletter for
employees.
Stroke Public Service Announcements were delivered to television and radio stations
in our local area.
Hospital Matrix boards were available in the caf, family waiting room for surgery,
and lobby. Stroke information was rotated with other content, covering signs and
symptoms, risk factors, and the F.A.S.T. test.
"On-hold" stroke education messages on the phone system during May.
"Are You Stroke-Smart" 11 community education sessions presented by the
Stroke Unit Outreach Nurses. Sites included Senior Centers, Health Fairs, Churches,
and Support Groups.
Redmond Regional Medical Center (RRMC)
RRMC had a great Stroke Awareness month in May. We started the month off with a bang at our Wellness Works seminar where Dr. David Hale, neurologist, gave a wonderful talk about Stroke Awareness. This was open to the public and there was standing room only. Redmond provided a stroke-healthy meal and wonderful giveaways for participants to take home as a guide to healthy living and knowing signs and symptoms of stroke and what to do if there is ever any question. We had an array of questions that Dr. Hale was able to answer to the group before Dr. Shereef Girgis (Harbin Clinic Physical Medicine and Rehabilitation) took the spotlight to speak about what Redmond has to offer stroke patients at our Inpatient Rehabilitation Center. The whole experience was a success and members of the community left feeling more knowledgeable about stroke in general.
For staff at RRMC, we opened up the hospital to receive free popcorn in a commemorative cup. It was a well attended function and we placed cards around all the tables in the dining room. We were able to answer questions relating to stroke on an individual basis. The cafeteria was also involved and made specialty menu items that were stroke-healthy each day for the month of May. Stroke facts were presented in the cafeteria throughout the month.
We had a fun game with any of the staff that wanted to participate. We collected nutrition labels off any food item for the entire month. We suggested the importance of watching for sodium content when preparing foods, as this is a leading cause of hypertension and stroke. At the end of the month the labels were all tallied and the winning 2 participants received a very nice duffle bag with the Redmond logo embroidered on the side.
We showered the town with Stroke Awareness Flyers at the mall, grocery stores, and physician offices. The city of Rome definitely felt the love and compassion that Redmond Regional Medical Center has for patients of all types, but especially those suffering with a stroke. At Redmond... WE CARE (Compassion Accountability Respect Ethics).

Saint Joseph's Hospital Atlanta
One of our Stroke Advisory Committee members presented during a lunch and learn session for hospital employees. The topic was diet-related stroke risk factors with an emphasis on sodium in the American diet.
In an effort to provide additional education to employees and visitors, members from our Stroke Advisory Committee performed blood pressure checks, risk factor assessments, and distributed educational materials and giveaways (cookbooks, risk factor assessments, pens, FAST cards, meal plans) to employees and visitors in the cafeteria.
The nurses on the neurovascular/stroke unit celebrated stroke awareness month by having a potluck meal. The nurses received Clinical Neuroanatomy books from the neurovascular/stroke Unit Director in recognition of their efforts to improve outcomes for stroke patients. We had a great stroke awareness month!
Southern Regional Medical Center
Southern Regional Medical Center's Stroke Program kicked off Stroke Awareness month by participating in a hospital wide heath fair, "Spring Into Healthy Living." Over 300 people attended the stroke fair hosted by the hospital at the end of April. The participants were able to receive free BMI analysis, cholesterol, blood pressure and blood glucose screening along with a one-on-one stroke risk assessment. Those who stopped by the stroke program table also received a stroke fan with the signs and symptoms of stroke along with the message to call 911. There were other free health screenings and information available as well.
Also on display all month was a banner announcing stroke awareness month and a bulletin board outside the cafeteria with the signs and symptoms of stroke and the act FAST message.
Strides in Stroke Fairview Park Named Primary Stroke Center and
Receives Esteemed State Award
Fairview Park Hospital recognizes that stroke is the third leading cause of death in the United States and that Dublin/Laurens County is right in the middle of the "buckle of the stroke belt." As a result, Fairview has responded to this challenge to ensure best care for their stroke patients. Recently, state and national organizations of excellence have recognized the strides made right here in their county.
After undergoing an on-site evaluation and demonstrating compliance with nationally developed standards for stroke care, Fairview Park Hospital has earned The Joint Commission's Gold Seal of ApprovalTM for certification as a Primary Stroke Center.
"In stroke care, time is brain," says Jean E. Range, M.S., R.N., C.P.H.Q., executive director, Disease-Specific Care Certification, The Joint Commission. "By achieving certification as a Primary Stroke Center, Fairview Park has proven that it has the ability to provide effective, timely care to stroke victims and can significantly improve outcomes for stroke patients."
The Stroke Team at Fairview Park Hospital was also honored with the 2012 Georgia Coverdell Champion Hospital of the Year Award by the Georgia Coverdell Stroke Registry. One of only four hospitals in the state, Fairview Park is at the top of the list for hospitals 101-350 beds in size. Data for the award was collected during the time period from January 1, 2010 through December 31, 2011.
"I am excited about our stroke program and our ability to provide neurology services 24/7," says Rob Ward, Director of CardioPulmonary Services & Coordinator of the Stroke Program. "We continue to improve our performance regarding this population and it's awesome to be recognized for our hard work. We have seen lives changed as a result and that makes it all worth it!"
Each year about 795,000 people experience a new or recurrent stroke, which is the nation's fourth leading cause of death. On average, someone suffers a stroke every 40 seconds and someone dies of a stroke every 3.1 minutes. Stroke is a leading cause of serious, long-term disability in the United States, with about 4.7 million stroke survivors alive today.

St. Mary's Hospital - Next Step 5K
Survivor raises awareness, funds for St. Mary's stroke programs
In late 2010, Oconee County High School English teacher Sally Baker needed to set a big goal as she worked to recover from the effects of preeclampsia, fetal loss, and a devastating stroke. But she wanted to do more. She wanted to thank St. Mary's Health Care System for helping her through the darkest days of her life. And she wanted to make a difference in the lives of other stroke survivors.
So Sally did not just walk a 5K in April 2011. She created one. In the Next Step 5K's first year, more than 100 people turned out to support Sally and St. Mary's stroke program, walking or running the 3.1-mile route around the track and grounds of Oconee County High School. Major media coverage prior to the event, including a segment aired by Fox5 Atlanta, stressed key educational points, such as the signs and symptoms of stroke, that stroke is a medical emergency, and that stroke can happen to anyone, of any age. This year, Sally reprised her Next Step 5K, this time inviting four other stroke survivors to co-host the event. On April 28, Sally, Kyle Clay, Joe Comfort, Garnett Dress, and Randy McCauley led an enthusiastic and diverse group of people in a celebration of the fight against stroke and the continued recovery of the five survivors. "Although we are all of different ages, races, and walks of life, the recovery and rehabilitation of a stroke is similar," Sally said. "Each survivor has said words that I know have come out of my mouth, and this is the reason why the Next Step 5K is so important. We share this tragic event in our lives, but the care we received has helped us move beyond it, and now we are coming together to help others."
Sally Baker At 30, Sally had a stroke after developing preeclampsia. Working with
St. Mary's Rehabilitation Services, Sally soon was able to walk and talk again, returned to work, and founded the Next Step 5K.
Kyle Clay A blood vessel malformation caused Walton County firefighter Kyle to
have a stroke at age 20. After hearing Sally's story, he chose St. Mary's for rehabilitation. Today he shows almost no signs of stroke.
Joe Comfort A former UGA football player, Joe collapsed with a stroke at age 71.
With intensive rehab from St. Mary's Center for Rehabilitative Medicine, Home Health Care and Outpatient Rehabilitation Center, Joe has returned to active living.
Garnett Dress When Garnett was rushed to St. Mary's with stroke symptoms, she
was able to receive tPA, a powerful clot-busting drug that stopped her stroke in its tracks. Today, Garnett shows no signs of having had a stroke.
Randy McCauley Randy was 42 when an undiagnosed blood disorder caused a
stroke. Emergency surgery at St. Mary's saved his life, but he could barely talk or feed himself. Today, he speaks clearly, swims three hours a day, and is beginning to walk again.
"We are seeing real progress in our community's level of awareness of stroke," said St. Mary's stroke coordinator Shelley Nichols, RN. "However, there are still many misconceptions, especially the idea that stroke symptoms will just go away. Too many patients who could benefit from therapies such as tPA wait to seek care and miss the window of opportunity. With the help of the Next Step 5K, we're working to raise awareness that stroke is a medical emergency and that fast treatment can make a real difference for many patients."
Stroke survivor Jeremiah Wiggs crosses the finish line, completing all 3.1 miles of the 2012 Next Step 5K
Submitted by: Mark Ralston, Manager of Public Relations, on behalf of St. Mary's Healthcare System, Athens, GA

16 Minutes and Counting
Hello Coverdell colleagues. I'm excited to share some practice changes that have positively impacted our D-T-N times. As we all strive to decrease the time it takes for our patients to receive IV tissue plasminogen activator (t-PA), we have to constantly analyze our processes to see where we can effect change. Over the past year, the Marcus Stroke & Neuroscience Center (MSNC) has been able to implement three specific elements that may also make a difference in your hospital. Even if you cannot replicate what we have done, think about your resources and the people who may be able to implement these ideas and strategies.
The first change was to have a dedicated pharmacist attend a code stroke in the ED. This individual tracks data points such as when the code stroke page was initiated, when the bolus and infusion began and any reasons that there may have been a delay in the administration of t-PA. The pharmacist is responsible for getting the weight and double checking with another clinician, mixing the t-PA, starting the bolus and infusion and documenting these things in the electronic medical record. Once the drip is hung, the primary RN takes over the infusion management. We have seen a gradual decrease of 50% in door-to-needle time.
The second change involved the pharmacist bringing the IV t-PA to the CT scanner in anticipation of giving the drug. We have all heard the axiom, `find reasons to treat.' By being pro-active and assuming we would treat the patient, this overall mindset affects the entire treatment team.
The third change is related to blood pressure management. Once again, the dedicated ED pharmacist has been a tremendous asset. The pharmacist brings the common blood pressure lowering medications to the CT scanner. If neither the t-PA nor the blood pressure medications are required, they are easily returned to the pharmacy pyxis machine.
Understandably, not all hospitals have the resource of a dedicated pharmacist. However, you may have this resource for at least part of the day; maybe day shift. Perhaps your rapid response team, stroke nurse champion, ED charge RN, or physician extender can fill in during the night shift.
As I write this I am proud to say that our record for D-T-N time is 16 minutes. It's a number we hope to beat and repeat many times. We still have process challenges and are working on them to establish 16 minutes as part of a trend and not a blip!
Submitted by: Amy Perez, Stroke Coordinator, Marcus Stroke and Neuroscience Center, Grady Health Systems
Coverdell Highlights
June Conference Call
Our guest speaker on the June Coverdell conference call was Trish Westbrook. Trish is the Stroke Coordinator and Director of Disease Management at Northeast Georgia Medical Center and she presented on "Writing and Publishing Readable Patient Education." Thanks Trish for a great presentation.
July Conference Call
Jim Groover is the AHA Director of Quality Improvement Initiatives in Georgia and East Tennessee. On our July call, Jim presented on "Bridging the Gap between EMS and the ED." We thank Jim for kicking off the new Coverdell funding period with this most informative presentation at such an appropriate time.
August Conference Call
Thank you to Lydia Clarkson, the PI of the Georgia Coverdell Acute Stroke Registry, for presenting on Coverdell and our plans as we move forward to work more closely with EMS on the Stroke System of Care. Lydia gave a wonderful and concise presentation on the next three years of Coverdell.
If you have not received any of the presentations and would like one, e mail Kerrie Krompf at: kkrompf@emory.edu.