Crittenton Hospital Medical Center Primary Stroke Center. Cesar D.Hidalgo, MD. Stroke Program Medical Director

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Crittenton Hospital Medical Center

Primary Stroke Center

Cesar D.Hidalgo, MD

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• 290 bed all-inclusive medical center

• 500 physicians

• 54 medical specialties

• full scope of inpatient, emergency and surgical

care to more than 40,000 patients annually

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• Residents from Wayne State University School

of Medicine specializing in:

– Family Medicine – Internal Medicine

– Ear, Nose and Throat

– Transitional Year Residency Program

• Oakland University School of Nursing

– Endowed Professorship in Nursing

– Support for our new program focused on relationship-based care in nursing excellence

• Rochester College School of Nursing

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4 • 290 Licensed Beds • 21 ICU Beds • 20 Psych Beds • 11 Pediatric Beds • 24 Rehab Beds • 32,000 ER/PUC Visits • Orthopedics • Mother/Baby • Hyperbaric Chambers • Interventional/Cardiac Surgery Program • Cancer Program Sponsored by American College of Surgeons Commission on Cancer • Primary Stroke Center • Therapeutic Hypothermia • Accredited Chest Pain

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• 6/24/2011

• Re-Certification July 2, 2013

– Comprehensive stroke focused program – Trained in stroke care

– Individualized care of the Brain Attack Coalition and guidelines to meet stroke patients’ needs

– Stroke care based on recommendations by the AHA/ASA – Collection of hospitals stroke-treatment performance data. – Use of data to assess and continually improve quality of

stroke care for stroke patients – Foster better outcomes

The Joint Commission –

Certificate of Distinction

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194 233 203 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250 2010 2011 2012 N u m b e r o f p a ti e n ts Year

CVA - Discharged Primary Diagnosis

Patients Linear…

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• Initiatives

– Mock Drills

– tPA Task Force – EMS to CT

– Charge Nurse Role

– Perfect Serve Stroke Alert (6/2013)

Door-Needle Time

Since 2011

33%

0 50 100 150 200 250 300 350 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 20112011201120112011201120112011201120112011201120112011201120112011201120122012201220122012201220122012201220122012201220122013201320132013201320132013201320132013 Door-Needle Time 2011 - Present Door-Needle Time

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• 15 Transport agencies in Macomb and Oakland Counties.

• CHMC receives approximately 500 ambulance transports each month.

• 55% of all EMS transports result in admission to the hospital.

– Average 29,000 ED visits per year.

– Quarterly EMS Manager meetings – communication with process improvements in the “field to hospital”.

– Pre-Hospital education offered to EMS providers

• 12 lead EKG interpretation • Stroke Education

• Pediatric Airway • ACS, ACLS, PALS

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Waterford TwpFD Addison Twp FD Oakland Twp FD Brandon Twp FD Star EMS Auburn Hills FD Community EMS Alliance EMS Washington Twp FD Shelby Twp FD Rochester Hills FD Oxford FD Bruce- Romeo FD Independence Twp FD Rochester City FD Crittenton Hospital

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• Innovation with Mobile Application

•ER Status

•Communication/Operations

•Geomap

Emergency Medical Services-

Always Connected

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Radio EMS Report to ED

•Cincinnati Stroke Scale

•Last known well time

•Actual weight upon arrival

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CT/Lab Order to Results

1/1/13-7/1/2013 20 20 25 17 59 14 13 18 26 17 18 17 23 15 11 39 38 35 38 16 40 26 15 21 43 28 60 18 6 0 5 10 15 20 25 30 35 40 45 50 55 60 Mi n u te s 2013 TPA Patients

ED - CT and Lab Order to Results Goal < 30 Minutes

CT Labs CT

Avg CT- 20.8 min Avg Lab - 32.2 min

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90 68 41 71 81 55 74 60 30 29 66 32 74 25 29 0 60 120 180 240 300 360 Mi n u te s 2013 TPA Patients ED - Door to Needle Goal < 60 Minutes Door to Needle Walk-in Avg = 90 EMS Avg = 52.5 Total YTD Avg = 55

Stroke Alert (6/1) 44.6 min

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• Received Commission on Accreditation of Rehabilitation Facilities (CARF) 2010 for Stroke Specialty

• Re-Certified June 2013

– Only 1 of 2 certified programs in Southeastern Michigan

– Assurance to persons seeking services that a provider has demonstrated conformance to internationally accepted standards.

– Person-focused standards that emphasize an integrated and individualized approach to services and outcomes.

– Management techniques that are efficient, cost-effective, and based on outcomes and consumer satisfaction.

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• 11/18/11 – Dr. Andrew Xavier, Vascular Neurology Topic and Description TBA

• 5/21/12 – Community Stroke Education – Deb Miller,RN,PT • 9/12/12 – Stroke Prevention & Carotid Arterial Stenosis,

Samer Kazziha, MD, Cesar Hidalgo, MD • 9/15/12 – Stroke Symposium

• 11/13/12 – Stroke Prevention, Cesar Hidalgo, MD • 1/16/13 – Stroke - “Cerebrovascular Accident is no

Accident”, Cesar Hidalgo, MD

• 4/15/2013 – Rochester Athletic Center Open House – “Just Move” - Stroke Education & Prevention – Deb Miller, RN,PT • 4/17/13 – Stroke Rehabilitation, Christopher Schoenherr,

MD

• 5/30/13 –Stroke Awareness – Chrysler Tech Center, David Bauer, MD, Glenn Garwood, Cesar Hidalgo,MD, Bernie Hung

• Monthly – CHED One Stop Screening

• Mobile App and website information (recently awarded Interactive Advertising Competition Award for Outstanding Website)

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INDICATIONS FOR POSSIBLE TRANSFER OF ISCHEMIC CVA PATIENTS TO COMPREHENSIVE STROKE CENTER

1. Awakening strokes

2. Patients with contraindication to IV-TPA, e.g. recent surgery or bleeding in non-compressible site, full anticoagulation, pregnancy

3. Lack of response to IV-TPA

4. Large strokes in patients outside of IV-TPA time window

Presupposes demonstration of clot in proximal intracranial or extracranial

artery, and significant ischemic penumbra (radiologic or clinical) in order to avail of mechanical thrombectomy