TMC receives Get With The Guidelines-Stroke Gold Plus Quality Achievement Award

American Heart Association Award recognizes Tucson Medical Center’s commitment to quality stroke care

 

StrokeRecognitionIconTucson Medical Center has received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

TMC earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients.

Before discharge, patients should also receive education on managing their health, get a follow-up visit scheduled, as well as other care transition interventions.

“Tucson Medical Center is dedicated to improving the quality of care for our stroke patients by implementing the American Heart Association’s Get With The Guidelines-Stroke initiative,” said David Teeple, MD, and the director of TMC’s stroke care program.

“The tools and resources provided help us track and measure our success in meeting evidenced-based clinical guidelines developed to improve patient outcomes.”

TMC additionally received the association’s Target: StrokeSM Elite Honor Roll award. To qualify for this recognition, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke.

“We are pleased to recognize TMC for their commitment to strokecare,” said Eric E. Smith, M.D., national chairman of the Get With The Guidelines Steering Committee and an associate professor of neurology at the University of Calgary in Alberta, Canada. “Research has shown that hospitals adhering to clinical measures through the Get With The Guidelines quality improvement initiative can often see fewer readmissions and lower mortality rates.”

According to the American Heart Association/American Stroke Association, stroke is the No. 5 cause of death and a leading cause of adult disability in the United States. On average, someone in the U.S. suffers a stroke every 40 seconds and nearly 795,000 people suffer a new or recurrent stroke each year.

 About Get With The Guidelines®

Get With The Guidelines® is the American Heart Association/American Stroke Association’s hospital-based quality improvement program that provides hospitals with tools and resources to increase adherence to the latest research-based guidelines. Developed with the goal of saving lives and hastening recovery, Get With The Guidelines has touched the lives of more than 6 million patients since 2001. For more information, visit heart.org/quality.

Our greatest reward is caring for our patients. That’s why we’re committed to turning treatment guidelines into lifelines. Tucson Medical Center is dedicated to helping our patients achieve the best possible outcomes, and implementing the American Heart Association/American Stroke Association’s Get With The Guidelines program will help us accomplish that by making it easier for our teams to put proven knowledge and guidelines to work on a daily basis.

 

An Emergency Room Visit: A Patient’s View

Emergency DepartmentNothing is more frustrating that sitting in the emergency room feeling terrible and watching someone who looks perfectly fine walk in and walk straight through to triage and be taken back. Right?

I recently got to be that person skipping the waiting room, moving straight past go to immediate help.

I felt fine, well except for the piercing headache behind my left ear that had been there for three days, but that hadn’t brought me into the emergency room. What brought me in was when one side of my face began to droop.

It was quite odd. At first it was just that my eyes didn’t look the same as usual. One seemed bigger than the other and then my face started to seem flat on one side.

Signs of a stroke

I recognized the drooping face as a possible symptom of a stroke and after I called my husband and dropped off the kids with some friends, I had a friend take me to the emergency room. Not my brightest moment. After all, if this was a stroke I was wasting precious brain time, but at least I didn’t drive myself! I couldn’t possibly be having a stroke – could I? After all my mum was 70 when she had her stroke. I was just 48 years old – a spring chicken. While I am definitely overweight, I didn’t have other risk factors.

I raced up to the front desk in the emergency room and began to explain my concerns. By this point my mouth was beginning to droop, too. The nurse took one look at me and whisked me back.

I’m sure to those left in the waiting room this seemed massively unfair. After all, there I was, able to walk, apparently in not significant distress, no bleeding or obvious trauma (they couldn’t see my face) and I was going to be seen before everyone else waiting.

Within a couple of minutes members of the rapid response stroke team were evaluating me for a stroke, bloodwork was being taken, and my situation was being evaluated. After the initial evaluation they were pretty sure I wasn’t having a stroke, but it wasn’t clear what was going on and something was definitely going on. Most of the possible scenarios and options were pretty awful. Center for Neurosciences nurse practitioner Frances West and neurologist Dr. David Teeple kept me calm and informed and made the decision to keep me at the hospital for observation.

The following day, after ruling out a possible reemergence of an earlier melanoma, the pieces began to fall into place. I had Bell’s palsy.

Bell’s Palsy

Bell’s palsy affects about 30,000 to 40,000 people every year in the United States. It results in the paralysis or weakness of one side of the face as a result of damage to the facial nerve. The cause of Bell’s palsy isn’t known, but generally the weakness or paralysis is thought to be due to swelling of the nerve in the area where it travels through the bones of the skull. For many, symptoms often begin to improve right away, but it may take weeks or even months for the muscles to get stronger. For some people symptoms may never completely disappear.

Six months out, my face is still lopsided. I can’t drink straight from a bottle, and talking at length can be tiring and embarrassing as I drool when my mouth tires. However, I can blink and smile. My facial paralysis isn’t quite as obvious as it was previously.

Bell’s palsy is not pleasant, but as my ability to parent, work, live and be an active member of my community is not impacted by my looks, I’ll take this slightly lopsided smile over the other possibilities like stroke or brain tumor.

I am grateful to know that if it had been a stroke, the TMC Rapid Response Stroke Team was ready to act, and the front desk staff prepared to recognize and move on a possible stroke case. And next time I’m in the waiting room of an emergency room … I’ll be a tad more patient as a new arrival is whisked back before me even if they don’t look sick.

While Tucson boasts a half-dozen stroke centers, TMC is the city’s only primary stroke center that has 24/7 coverage by board certified interventional neuroradiologists along with a neurology and neurosurgery stroke team.

Rachel Miller is a Communications Specialist at TMC.  She has decided since developing Bell’s palsy that everyday should be pirate day. (Individuals affected by Bell’s palsy are often unable to close or blink the eye on the affected side. A patch protects the eye from the everyday dust. Here Rachel takes advantage to play pirate.)

Mission Moments: Missing tennis shoes meet a bulldog of a nurse

After an elderly patient left Tucson Medical Center following a stroke, her sister called in a panic.
The patient had compromised movement with partial paralysis of the left side that required special shoes to help with her mobility. They would be important in physical therapy sessions to help rebuild her strength.

And they were missing.

Will Bascom was the charge nurse that evening in the Emergency Department when the frantic call came in. He promised to track them down.

They weren’t in the Emergency Department and they weren’t in the room she recovered in. It took a bit of sleuthing, but ultimately it turned out they already had been brought back to the patient’s care home and were waiting for pickup.

The patient’s sister called later to say how appreciative she was. “Amidst his busy scheduled, he hunted them down. I can’t say enough about how he treated me when we were going through such a hard time.”

For Bascom, of course, he was going to help.

“More often than not, we see people in some of the worst times of their lives. It’s as simple as that. So if I get a request like this – to help someone out at a time when they’re going through this life-changing event and even a small thing means the world in that moment – I’m like a bulldog,” he said.

Bascom said people typically get into health care because they have compassion and empathy for others. “I treat everyone like my own family. I don’t care why you’re here and where you’re from. I’m not a judge. My job here is to take care of you. I think many people just lead such busy lives that it’s hard to have time for anyone else. I’ve always done what I could to help others.”

Tucson Medical Center earlier this year adopted a new mission statement. To celebrate, we are sharing an ongoing series of “mission moments.”

What are mission moments? They aren’t necessarily dramatic stories of heroism, although our medical staff saves lives every day. These are moments that breathe life into words – moments that are profound or powerful or touching and that remind us why we do the work we do. Hundreds of these reminders happen every day. Thank you for letting us share some with you.

Do you have a TMC mission moment you’d like to share? Send it to Communications@tmcaz.com.

Three reasons to have a vascular screening

3 reasons to have a vascular screeningMeet Ashley Marcolin, registered vascular technologist at TMC and one of six RVTs that perform vascular screening exams at TMC. Ashley is the newest addition to the team, but manager Sarah Yeager reports Ashley reflects the kindness, compassion and empathy typical of the whole team.

“When people come in for a vascular exam they’re often very nervous. Whether they’re in the hospital for a vascular-related concern or a vascular wellness screening, I want them to know that they can relax, this is a very non-invasive test. We use no radiation, no dyes, no needles, and it takes just 30 minutes.” Ashley said. “This really is a very simple way to catch serious conditions early before they become life-threatening. The screening can save a life, and it takes very little time.”

While Ashley is a new member of the team, she has a lot of experience with performing exams of this kind. In her training, she had to complete 960 clinical hours using the techniques she now uses every day. We calculated how many exams she has performed since she started at TMC, where she also completed her clinical training. It runs into the thousands. “You know when you come to TMC that your technologist is a registered vascular technologist and has undergone a two-year intensive or four-year course before they can even take the certification exams,” Sarah explained.

What is involved in a vascular wellness screening?

We do three separate tests that together take about 30 minutes. You need to fast for four hours beforehand and wear loose-fitting clothing that allows easy access to the abdomen, neck, legs and arms. You do not need a doctor’s referral to schedule an appointment, but we will need the name of your primary care physician to send the results.

Ankle-Brachial Index

We use ultrasound scans along with blood pressure cuffs on the ankles and arms to screen for blockages or signs of disease in the arteries of the limbs. For this exam, you need to take your shoes and socks off. This is a screening for peripheral artery disease. PAD is a very common condition, especially in people over the age of 50. PAD can cause chronic leg pain when you’re walking or performing other exercises.

Abdominal Aortic Aneurysm Screening

This screening uses ultrasound scans looking for a ballooning of the wall of the abdominal aorta. If this ballooning or aneurysm ruptures it can be fatal. For this screening, you lie on your back while an RVT places the ultrasound transducer on several areas of your abdomen. The transducer has a bit of warm gel on the end. The gel helps us get clearer pictures and will not hurt your skin. You may feel slight pressure from the transducer as it moves along your body.

Carotid Artery Duplex Evaluation

Using an instrument called a transducer, the RVT scans the carotid artery in your neck to check the flow of blood, which informs us of plaque and blockages that put you at risk for an ischemic stroke.

Should you get a vascular screening?

Sarah and Ashley suggest that everyone over the age of 50 with any of the below listed risk factors get a vascular screening, and that any additional testing or screenings should be repeated at your physician’s direction.

find a doctor in Tucson

You may also be at increased risk of arterial vascular disease if you have one of the following:

  • Have a family history of abdominal aortic aneurysm
  • Smoke or have a history of smoking
  • Have diabetes
  • Have high cholesterol and/or high blood pressure
  • Have coronary artery disease

When will I get the results?

Our exams are read in house by a vascular surgeon and the results sent to you within 3-5 days.

Three reasons to have a vascular screening:

  1. It’s quick, easy and painless
  2. It’s affordable
  3. It can help prevent stroke and detect abdominal aortic aneurysm and peripheral artery disease

Call (520) 348-2028 to schedule your vascular screening.

vascular screening special

Stroke Prevention Saturday April 15 at TMC

Are you at risk for a stroke? Join TMC and HealthSouth Rehabilitation Institute of Tucson for the annual free Stroke Prevention Saturday, April 15, 7 a.m. to noon at TMC Marshall Conference Center.

Free testing for:

  • Height, weight and body mass index
  • Blood pressure and oxygen saturation
  • Glucose and cholesterol measurements
  • Carotid Doppler ultrasound to look for blockages or narrowing
  • Electrocardiogram

A physician will review your results with you.

The screening is recommended for those 50 years and older. For best results, an eight-hour fast is recommended.

In addition, to learning about their risk for stroke, participants will also receive information on recognizing the signs of a stroke and how to control risk facts and the signs of a stroke.

No appointment necessary. Please allow 45 minutes for screening.

Light snacks will be available.

Click for a flier with map and, also, a Spanish-language version.

Local fire captain on the mend after catastrophic aneurysm

IMG_0612On March 26, Rural/Metro Fire Captain Eric Cline was celebrating his fourth wedding anniversary with his wife, Risa, when he complained about his head hurting and suddenly collapsed. Cline suffered a brain aneurysm that then caused a stroke. He was rushed to Tucson Medical Center where Kurt Schroeder, M.D., a neurosurgeon from the Center for Neurosciences, helped save his life.

Stephanie Innes from The Arizona Daily Star wrote this story about Cline, the incredible camaraderie displayed by his firefighting family and just how rare this diagnosis is in a young person. Cline, a father of three, is only 40-years-old.

Sam Salzwedel from KVOA News 4 Tucson also aired this story about Captain Cline.

As a Neuroscience Center of Excellence, TMC is nationally recognized for its neurological and stroke care.

A miraculous recovery prompts Tucson stroke patient to give TMC staff a heartfelt thank you

This slideshow requires JavaScript.

Tucson Medical Center clinical staff will tell you that simply helping people when perhaps they need it most is all the reward they need in their noble profession.  So when a patient comes back to say ‘thank you’ following an extraordinary recovery, it is instantly uplifting for them.

Sandy Goodsite recently came back to say ‘thank you,’ and hug the people who she credits with not only saving her life, but also giving her the quality of life she essentially had before April 22, 2014.

That’s when Goodsite, 72, suffered a significant stroke. She was rushed to TMC and received a clot-busting drug called tPA just 22 minutes after hitting the doors of the Emergency Department (ED), one of the fastest response times in the city.  You can read about her incredible ordeal here.

Goodsite is now about 95 percent recovered, as she continues speech and occupational therapies.  She and her husband, semi-retired pediatrician Dr. Ron Goodsite, felt compelled to come back and personally thank those who were working the day she was brought in via ambulance.  They were armed with thank you notes, addressed to every staff member who helped care for her.  As the Goodsites were ready to make their way to their first stop, they were greeted in the lobby by two members of the Neuro Red team, which responds to stroke victims.  “Talking to her, and seeing how well she’s doing reminds me why we do what we do,” said Shannon Bachman, RN.

The Goodsites headed inside TMC’s ED where staff was just as touched that Sandy is not only doing so well, but also took the time to come back.  “It is so fantastic that she came back because it’s typically very rare that we get to see a patient after they leave the ED,” said Heather Williams, ED clinical nurse lead.  Melissa Ritchey, director of TMC’s ED, echoed that sentiment.  “It reminds us why we come to work each day.  I’m so grateful that she came back to say thanks.  You only need to hear that one time to remember each and every time why we do what we do.”

Next stop: TMC’s Intensive Care Unit where Goodsite was greeted and immediately recognized by staff who hadn’t seen her since her two-day stay there in April.  “It’s so nice to see you up walking and talking!” said Jenny Tuttle, ICU clinical nurse lead.  “We always appreciate when people take the time to come back because we see them in a bed, in an acute setting.  It’s not very often we get to see the progress they’ve made, so it means a lot to us to see her doing so well,” she said.

On the neurological unit, clinical nurse lead Nancy Box said she was in awe.  “It’s so neat to see somebody come back and look so good because we rarely get to see the end result.  When they leave here, they typically have some sort of deficit, so it’s amazing to see Sandy talking and moving so well, and how her hard work during rehabilitation has paid off.”

The Goodsites are also catering a savory dinner for the three departments involved in Sandy’s care.  “We wanted to provide a little something for them – to do more than just say thank you,” she said.  But they realize that her incredible care started with the lightning fast response by Tucson Fire paramedics Bill Nielson and Robert Smith.  The Goodsites paid the boys in blue at station No. 7 a visit, and catered a dinner for the crew that was covered by the Arizona Daily Star and KGUN 9 On Your Side.

*Special thank you to TMC volunteer Mary Goeke who stayed late to accommodate the Goodsite’s visit.  Goeke helped transport the Goodsites from the different departments at TMC and said she felt honored to be a part of something so special.

TMC’s stroke response one of the fastest in the city; results in Tucson woman’s phenomenal recovery

“It was like serendipity.”

That’s how Dr. Ron Goodsite described his wife’s stroke, and subsequent response that led to her extraordinary recovery. Serendipity that everything fell into place as it did. “Sandy exhibits what an ideal patient’s response should be,” he said.

It happened April 22, 2014.

Sandy Goodsite TMC Stroke Survivor

Sandy Goodsite
TMC Stroke Survivor

Sandy Goodsite, 72, stopped by her medical management company for just a few minutes to get some things done when an employee noticed that she was unable to move, and staring into space. She realized something wasn’t right, and alerted Sandy’s daughter, who was in the next room. Sandy’s right side was beginning to droop. Her daughter immediately called 911. Within minutes, the office was full of firemen, and stunned employees watched as Sandy was loaded into an ambulance.

Longtime Tucson pediatrician Dr. Goodsite is now semi-retired, and works in the imaging department at TMC for Children. He was just finishing up his shift when his phone rang. It was his daughter telling him Mom was on her way in via ambulance. “It was really scary,” he said. “It can happen to any of us at anytime, and it can happen when you least expect it. When you have something like this that affects a loved one, it’s frightening.”

Sandy’s risk factors were well controlled. She had no symptoms. And absolutely no warning signs.

Her miraculous recovery started with the medic’s quick response time and communication to TMC that a suspected stroke patient was coming in. TMC is a designated Primary Stroke Center, and was recently honored with the Gold Plus award status for the fourth year in a row. TMC is also recognized as a recipient of the American Heart Association/American Stroke Association Target: Stroke Honor Roll.

Emergency Department staff triggered a hospital-wide alert called Neuro Red in which a team of people immediately report to the emergency room, including the rapid response nurse, house supervisor, lab technicians, and the neurologist on-call. In Sandy’s case, neurology resident Dr. Muhammad Kahn responded. Radiology was put on alert, and pharmacy was put on stand-by.

Sandy's stroke affected a significant  portion of her brain.

Sandy’s stroke affected a significant
portion of her brain.

As soon as Sandy hit TMC’s emergency department, her blood was drawn and a brain scan was performed. She had suffered an ischemic stroke, in which a blood clot broke off and traveled to the left side of her brain – the portion that controls speech and language. The stroke was significant. CT scans show the clot affected a baseball-sized portion of her brain. The right side of her body was completely weak, as is typical with stroke victims.

TMC Neurologist and Stroke Director Dr. David Teeple administered a drug called tissue plasminogen activator, or tPA. It’s approved by the FDA for treatment of ischemic stroke up to three hours after stroke, and works by dissolving the blood clot.

Ischemic stroke patients should get tPA within 60 minutes of hitting the emergency room. Sandy received it 22 minutes after she arrived at TMC, one of the fastest times in the city.

Dr. David Teeple TMC Neurologist & Stroke Director

Dr. David Teeple
TMC Neurologist & Stroke Director

“With stroke, time really is of the essence,” said Dr. Teeple. “Every minute, a stroke patient loses about 2 million brain cells. Every hour, they lose 120 million brain cells. The sooner you give tPA after the onset of stroke symptoms, the more effective it’s going to be. That first hour is really the golden hour where we can eliminate a lot of the brain damage caused by stroke if we administer tPA quickly. For Mrs. Goodsite to receive tPA 22 minutes after hitting the emergency room door is absolutely incredible.”

Six hours after tPA was administered, Sandy’s motor deficiency had disappeared. Sandy was in TMC’s intensive care unit for two days, followed by two more days in the neurological unit. Initially, she was unable to write. Her words all ran together. She mixed up right, left, up and down – a very common symptom of stroke. Sandy spent the next ten days at HealthSouth where she made big strides with her rehabilitation.

Each day, she started doing a little bit more. It didn’t take long for her ability to write and speak to come back. “My husband used to laugh because of my ability to multitask,” she said. “I’d work on three things at once, and it would drive him batty.” She’s working on being able to multitask once again, and also how to focus. She gets easily distracted, but did not lose any intellect during the stroke.

Dr. Ron & Sandy Goodsite

Dr. Ron & Sandy Goodsite

Dr. Goodsite finds himself wondering what would have happened if anything went differently that day. What if Sandy would have suffered that stroke while driving? What if those firemen were on another call, and it took them longer to respond? What if TMC wasn’t a designated Primary Stroke Center, and didn’t have the Neuro Red team in place? “We have a strong faith in God, and we believe we had help from above. We felt that someone was looking out for us, and especially looking out for Sandy,” said Dr. Goodsite.

Dr. Teeple said Sandy’s remarkable recovery is extremely gratifying from a physician standpoint. “This is the culmination of everything TMC, the city, and EMS have been working so hard on for the past five years. Since TMC is a Primary Stroke Center, we have the foundation in place to be fully prepared for these patients before they even get here. Everyone in every department that was involved – did the right thing, and worked together to get this result.”

“My appreciation of TMC has really gone up 1,000 percent since I’m now a person who has experienced this firsthand,” Dr. Goodsite concurred. “That day, I was at TMC – not as a physician, but as a husband. I am completely amazed at how the brain is able to recover once tPA is administered. But beyond that medication – the Neuro Red team TMC has in place – is incredible. As soon as Sandy hit the doors at TMC, she was immediately taken to the exam room and then her brain was scanned, and the tPA was administered. The response was remarkable.”

Doctors are still trying to find out exactly where the clot came from in Sandy’s body. She’s about 95 percent recovered, and making incredible strides with the occupational and speech therapy she is receiving twice a week. She has what’s known as expressive aphasia – similar to when you have a thought or a word “on the tip of your tongue.” It’s in your head, but you’re just having a hard time retrieving it. Day by day, however, she’s making big improvements.

The Goodsites have plans to formally thank the medics and TMC staff members who did everything right that day, which aided in her quick recovery. Dr. Goodsite said, “I can’t wait for Sandy to walk in, and see these people, and say ‘Thank you.’”

May is Stroke Awareness Month – Know the symptoms!

 stroke logo
May is National Stroke Awareness Month.  A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts.  During a stroke, 32,000 brain cells are lost per second, 1.9 million are lost per minute, and 120 million are lost per hour. 

Primary Stroke Cntr logo Hi-resTIME is brain!  Know the signs and act F.A.S.T.  If you or someone you witness is having a stroke, call 911 immediately for quick care and treatment.

Tucson Medical Center is a Primary Stroke Center that offers comprehensive 24/7 neurology, neurosurgery, and interventional neuroradiology coverage. 
  stroke

Statistics:

▪  Stroke is the #1 preventable cause of disability
▪  Stroke is the #4 cause of death in the U.S.
▪  Every 40 seconds, someone has as stroke 

Modifiable risk factors:

▪  High blood pressure
▪  Heart disease
▪  High cholesterol
▪  Carotid disease
▪  Atrial fibrillation
▪  Diabetes
▪  Physical inactivity
▪  Obesity
▪  Heavy alcohol use
▪  Drug abuse and tobacco use

Prevention:

▪  Don’t smoke
▪  Eat lots of fresh vegetables, fruit, fiber and fish
▪  Keep moving!  Get at least 30 minutes of brisk walking most days
▪  Keep your body mass index (BMI) less than 25
▪  Manage cholesterol – less than 200, and LDL less than 100 is ideal
▪  Manage blood pressure – less than 120/80 is ideal
▪  Managing fasting glucose – less than 100 is ideal

Stroke in everyday life:

These three scenarios are examples of how stroke symptoms affect someone in everyday life:

▪  While brushing your teeth, you notice the left side of your face is drooping. You try to smile, but it feels awkward.
▪  You are preparing a meal, your left arm drifts down and you notice that you have no control over it. 
▪  In the middle of a conversation, your speech becomes difficult to understand.

Other warning signs of stroke include a sudden change in speech, vision, strength or sensation, balance or dizziness, level of consciousness, or a severe headache.

Click here for more information about stroke.
Click here to learn more about the Spot a Stroke F.A.S.T. app.


Tucson Medical Center | 5301 E. Grant Road | Tucson, Arizona 85712 | (520) 327-5461