Speedier stroke treatment drastically cuts disabilities

If stroke patients are given tissue plasminogen activator (t-PA) within three hours of symptom onset, they are 30% more likely to recover with little or no disability. But only a handful of hospitals have developed plans for the rapid diagnosis and treatment required to save stroke patients from life-long disability. In addition, many patients don’t know the symptoms well enough to seek early treatment, says John Marler, MD, medical officer at the National Institute of Neurological Disorders and Stroke in Bethesda, MD. With 500,000 stroke patients a year nationwide, a rapid door-to-treatment process would save unnecessary suffering and millions in rehabilitation costs.

"There is now something we can do," Marler says. "The public needs to learn how to recognize and respond to stroke, and the medical delivery system needs to get organized to deliver the most rapid possible treatments." The clot-dissolving drug is effective only when the stroke is due to a blood clot, which causes 80% of strokes. But an accurate diagnosis is crucial because the drug could worsen other types of stroke. Hospitals need to develop a way to quickly distinguish the type of stroke, Marler says. "You can’t just wait for the patient to show up. You need to know ahead of time what to do and have a plan so you can do it rapidly."

Marler says his institution aims to create a system in which the stroke patient is managed in much the same way as a patient with serious trauma or in acute myocardial infarction is managed. Watch future issues of QI/TQM for descriptions of cutting-edge hospitals’ rapid stroke detection and treatment programs.