Novant Health Forsyth Medical Center leads the way in rapid response times for treating stroke

The care team at Novant Health Forsyth Medical Center is rapidly reducing response times for stroke patients. The Forsyth Medical Center team has dropped the average thrombolytic administration time from 27 minutes in 2022 to 20 minutes from January to September of 2023 with a recent switch from Alteplase to Tenecteplase for tissue plasminogen activators. This is well below the 60 minute benchmark set by the Brain Attack Coalition and 10 minutes below the top standard set by the American Heart Association Phase 3 Target: Stroke Guidelines of 30 minutes.

The hospital’s track record has won attention. The American Heart Association and American Stroke Association awarded Forsyth Medical Center with key recognitions: the Get With The Guidelines – Target: Stroke Gold Plus: Stroke Honor Roll Elite Plus, Advanced Therapy, and Target: Type 2 Diabetes Honor Roll.

Novant Health Forsyth Medical Center is a Certified Comprehensive Stroke center with a neurointerventionist, neuroradiologist, neurologist and neurosurgeon available to care for patients 24/7.The physicians regularly perform advanced procedures, including mechanical thrombectomies and endovascular procedures used to treat aneurysm and ischemic stroke.

“If the patient does not appear to be responding to the tissue plasminogen activator, neurosurgeons with a specialization in endovascular surgery may perform a mechanical thrombectomy to extract larger clots using a stent retriever,” said Colin McDonald, MD, medical director of the comprehensive stroke program at Novant Health Forsyth Medical Center. “The main thing to remember is that there are advanced stroke treatments available, but time is crucial with all forms of treatment.”

The key differentiator for rapid response times to stroke is the availability of a neurohospitalist and Rapid Response Team with a dedicated Neurology ICU RN around the clock at Novant Health Forsyth Medical Center. “We have an entire team of dedicated neurohospitalists who are assigned to the emergency room for 24/7 coverage – it’s unique,” said Amber Jones, chief nursing officer at Novant Health Kernersville Medical Center. “There’s such a limited amount of time to remove the clot, so having dedicated physicians specializing in that right in the emergency room is a game-changer. A lot of medical centers use teleneurology services for their program. It’s a great service, but boots on the ground streamlines the process so that there are no delays in starting stroke treatment.”

“It’s estimated that 2 million brain cells die every minute during a stroke, which leads to permanent brain damage, disability and death,” Dr. McDonald said. “The quicker patients receive treatment, the less damage can occur.”

The process starts before a patient even arrives to the emergency department – with highly trained EMS agents who pre-notify the Forsyth Medical Center team of potential Stroke patient arrivals. Our partnership with local EMS agencies allows our hospital to have our Stroke rapid responders waiting on arrival for incoming stroke patients. They often rule out stroke mimics pre-arrival. To save more critical time, as soon as a stroke patient is admitted at Novant Health, they are moved straight to the CT room where the entire workup is performed, from thrombolytics to advanced imaging. Forsyth Medical Center utilizes MRIs as needed, as well as standard CTs and CTAs. A newer form of advanced imaging the team often works with is CT perfusion, which allows the evaluation of the microcirculation of the brain.

“The patient doesn’t go back to the emergency room until the acute process is taken care of,” Jones said. “It decreases the time to treatment when a patient doesn’t need to get set up in another room first, but instead goes straight to where we provide all the care with the entire team present. ‘Time is brain’ is at the forefront of everyone’s mind.”

Faster treatment has a huge impact on a patient’s ability to recover from a stroke. “If the stroke is not evolved, we still have that penumbra we can save,” Jones said. “In that case, symptoms can usually be reversed, or they won’t be as severe.”

After acute treatment, a specialized team of stroke response nurses follows all patients that receive thrombolytics or thrombectomies over to the neuro ICU. The nurses collaborate with the main care team and other inpatient nurses to ensure a smooth continuation of care between rooms. Once in the neuro ICU, the patient receives care from neurointensivists who are specifically trained to help transition them to more standard medical treatment.

Providing a full continuum of care improves outcomes for patients. Novant Health starts that process from the time a patient comes in the door, to thrombolytic treatment, to a spectrum of therapies to aid in recovery including occupational therapy, physical therapy and speech therapy.

The Novant Health Stroke Bridge Clinic exists to bridge the gap from hospital admission back into the community. “We were one of the first in the nation to implement that,” Jones said. “After discharge, we work to support patients to make sure they get the follow-up they need to return to their previous state as quickly as they can. Our stroke navigators are part of that process. They see all patients when they come in the hospital with a stroke diagnosis and follow them through their entire stay, and later at the clinic. This ensures they have neurology coverage, a neuro-specific pharmacist reviewing medications, and an outpatient neurologist to see.”