From a primary to a comprehensive stroke centre: steps to success at St. Mary’s Medical Center and the Palm Beach Children’s Hospital



In 2008, St Mary’s Medical Center and the Palm Beach Children’s Hospital in West Palm Beach, Florida USA, initiated an ambitious transition from a primary to a comprehensive stroke centre, sparked by their insight into the undeniably increasing incidence of stroke based on changing demographics, and their understanding that: “If treatment is started in time, stroke does not have to lead to a poor prognosis.”

Dr. Ali Malek

The hospital began by purchasing their first biplane system;1 the first edition to their array of state-of-the-art GE Healthcare equipment that remains the workhorse. Following this, Ali Malek, a board-certified neuro-interventionalist, was brought in as medical director to help lead the program; his medical expertise and extensive training aiding the teams’ development and dedication to prioritising stroke care.

All in all, St Mary’s Medical Center and the Palm Beach Children’s Hospital noted that very few new hires were necessary. Instead, an on-going education process was implemented, with nurses, respiratory therapists, emergency services personnel educated through lectures, observation and hands-on training. Additionally, GE helped train staff on the use of new equipment, while Malek trained them on protocols and procedures.

Strict stroke protocols and care pathways were implemented, following an “If X, then Y” standardised structure. “Stroke treatment requires a consistent, accurate and precise process to do the best for the patient,” stated stroke team neurologist, Juan Ramos-Canseco. The hospital also acknowledged that response time is crucial for stroke, and each of these departments needs to have staff trained in stroke care, so when a “stroke alert” is called, the staff are ready to handle it accordingly.

The technology used from the initiation of the program remains an important factor to its success, with the major equipment purchased to support the program coming from GE Healthcare. “We purchased two biplane machines, along with CT and MRI products from GE,” said Malek. In addition to this, AngioViz2—an application designed to help physicians visualise characteristics related to blood flow, displays the result of increased perfusion pre- and post-treatment. Malek uses AngioViz on every stroke case, stating that: “AngioViz caters to the sensitivity of the human eye allowing us to see subtle defects in perfusion even after an embolectomy, which helps guide us to know when to stop.”

However, with some of the major advances that coincide with a comprehensive stroke program, new obstacles need to be overcome to ensure that new therapies are consistently translated into clinical practice. Close collaboration alongside a shared protocol should replace the previously fragmented approach to ensure best practice.

In order to execute this, the physicians at St Mary’s Medical Center and the Palm Beach Children’s Hospital reached out to local emergency medical services (EMS) providers to include them as part of their stroke team. For example, the first responders are continuously brought in to observe the beneficial nature and notable difference that the comprehensive stroke program provides; both within the walls of the hospital and throughout the community that the hospital serves.

Therefore, St Mary’s Medical Center and the Palm Beach Children’s Hospital also acknowledged that when setting up a comprehensive stroke centre, communication with the surrounding community should not be undervalued, with the assumption that an informed public will know the signs of stroke and call for emergency services quickly. Moreover, the surrounding hospitals need to establish a relationship of trust for the best patient outcomes, irrespective of the fact that they are essentially competitors.

The factors described above essentially consist of the four “steps to success” implemented by St Mary’s Medical Center and the Palm Beach Children’s Hospital: people, processes, technology and EMS communication. Yet, whether this transition from a primary to a comprehensive stroke centre may be an end in itself or pave the way for an even brighter future for stroke patients; the stroke team must remain aware of the new equipment, processes, procedures and research in order to provide the best care possible.

Nonetheless, Malek and the stroke team are striving to improve: “Our goal was that 100 per cent of all patients that are eligible for tPA, get tPA, and 100 per cent of all patients that are eligible for intervention, get intervention. That is what we have now, 100 per cent,” stated Malek.

St Mary’s Medical Center and the Palm Beach Children’s Hospital currently maintains a stroke database and works with The Joint Commission to ensure the hospital adheres to the American Stroke Association’s “Get With The Guidelines” parameters. The team also holds weekly meetings, where specific stroke cases are discussed, while a monthly CME (Continuing Medical Education) meeting is held for the entire hospital. In terms of the wider community, lectures and screening events are held regarding how to recognise the signs of stroke and when to call 911.

Thus, having a comprehensive stroke centre with an extensive level of treatment present in the community offers immeasurable benefits to everyone living there. In addition, the benefits of the same transition are evident to the hospital itself, as expanded services provide additional traffic. In the case of St Mary’s Medical Center and the Palm Beach Children’s Hospital, the institution expanded the entire service line for neurology, offering paediatric neurology and epilepsy treatment—resulting in the development of the Palm Beach Neuroscience Institute.

  1. Biplane system here refers to Innova 3131-IQ upgraded to be equivalent to Innova IGS 630
  2. Statements reflect users opinion. AngioViz is an option that requires AWworkstation

This advertorial has been sponsored by GE Healthcare


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