Stroke Emergencies: Hospitals With Dedicated Teams

Stroke care requires a coordinated, multidisciplinary team approach. A stroke team should include a stroke coordinator, a physician champion, emergency medical services staff, ED physicians and nurses, radiologists, lab staff, neurologists, physiatrists, rehabilitation nurses, physical therapists, occupational therapists, speech and language pathologists, clinical/neuropsychologists, dieticians, and social workers. The team should work together to provide personalized holistic care, with each member's unique skills and services contributing to improved patient outcomes. While not all hospitals may have a dedicated stroke team, they should have the necessary resources and personnel to provide timely and effective stroke care.

Emergency medical services staff

Emergency medical services (EMS) staff are often the first point of contact for stroke patients. They are crucial in providing rapid transport to the nearest stroke centre, which is essential as "time is brain"—every second lost can mean lost brain tissue.

EMS staff must be able to recognise stroke symptoms, such as a sudden loss of balance while walking or standing, or sudden trouble seeing out of one or both eyes. They should also be aware of the patient's medical history, including personal stroke risk factors such as high blood pressure, heart disease, smoking, diabetes, physical inactivity, obesity, high blood cholesterol, diet and nutrition. Recognising these risk factors is important as up to 80% of strokes are preventable by managing them.

Once the patient is admitted to the hospital, EMS staff work with the stroke team to ensure a smooth transition to the next level of care. This may involve collaborating with ED physicians and nurses, radiologists, and lab staff to provide rapid assessment and treatment.

Overall, the role of EMS staff in stroke care is critical in ensuring timely and appropriate treatment for stroke patients, which can significantly impact their recovery and long-term outcomes.

ED physicians and nurses

As the first point of contact for stroke patients, ED staff must be adept at recognising stroke symptoms, which can include sudden dizziness, loss of balance, and trouble seeing out of one or both eyes. They must also be aware of the time-sensitive nature of stroke treatment, as brain cells can die within minutes of a stroke occurring. ED physicians and nurses play a pivotal role in activating the stroke response, which includes notifying EMS providers and ensuring rapid transport to the nearest stroke centre.

Effective coordination and collaboration within the ED and with other departments are essential for successful stroke care. ED physicians and nurses should work closely with radiologists and lab staff to obtain and interpret brain imaging and lab results promptly. Additionally, they should communicate and collaborate with neurologists, who are specialists in stroke care and play a critical role in the acute stage of treatment.

The role of ED physicians and nurses in stroke care extends beyond the initial diagnosis and treatment. They are integral to the patient's ongoing care and rehabilitation. This includes educating patients and their families about stroke prevention and promoting wellness, and providing training to manage health problems associated with stroke, such as diabetes or high blood pressure. ED staff also facilitate the patient's transition to inpatient rehabilitation facilities, ensuring a smooth continuation of care.

In conclusion, ED physicians and nurses are vital members of the stroke team. Their ability to recognise stroke symptoms, initiate timely diagnostics, and collaborate effectively with other specialists sets the tone for the patient's journey. By providing high-quality, coordinated care, ED staff can improve patient outcomes, reduce disabilities, and save lives.

Radiologists and lab staff

In the context of stroke care, radiologists and lab staff work collaboratively to provide rapid and accurate assessments. They utilise advanced imaging technology, such as CT scans and MRIs, to identify clots or blockages in the brain's blood supply. This information is crucial for determining the most effective treatment approach, including the use of clot-busting medications or other interventional procedures.

The timely acquisition and interpretation of imaging results are vital in stroke treatment. Radiologists work closely with other members of the stroke team, including neurologists, neurosurgeons, and emergency physicians, to ensure seamless coordination of care. They play a critical role in expediting the diagnosis and treatment process, improving patient outcomes and reducing potential deficits caused by stroke.

Additionally, lab staff in the stroke team conduct rapid laboratory tests to support the treatment process. They work in conjunction with radiologists and other medical professionals to provide a comprehensive understanding of the patient's condition, enabling informed decision-making regarding treatment options. The integration of radiology and laboratory services ensures a holistic approach to stroke patient care.

The role of radiologists and lab staff in stroke teams is essential for optimising patient outcomes. Their expertise in imaging, diagnostics, and laboratory testing contributes significantly to the timely and effective treatment of stroke patients. By working collaboratively with other healthcare providers, they help improve patient care, reduce the impact of stroke, and enhance recovery prospects.

Stroke unit teams

The first point of contact for stroke patients is often the emergency medical services (EMS) staff, who provide rapid transport to the nearest stroke centre. ED physicians and nurses are then responsible for recognising stroke symptoms, completing a diagnostic work-up, and deciding on treatment options in collaboration with the team. Radiologists and lab staff are also key members, as they need to quickly acquire and interpret brain imaging and complete lab tests to determine subsequent treatment.

A multidisciplinary stroke unit team may also include doctors, nurses, physiotherapists, occupational therapists, speech and language therapists, clinical/neuropsychologists, dieticians, and social workers. Pharmacists, orthotics specialists, orthoptists, and chiropodists may also provide input. The team works closely with other departments, such as radiology, neurosurgery, vascular surgery, neurology, geriatric medicine, and cardiology, to provide personalised, holistic care.

Rehabilitation within a stroke unit team may include physical therapy to help survivors regain use of their limbs and improve movement and balance, and occupational therapy to re-establish motor skills for basic and occupational activities. Speech and language therapy can also be provided to improve functional communication, reading comprehension, and writing. Psychological interventions or medication may be offered to address cognitive and psychological impacts, and social workers can assist with decisions about living arrangements, insurance, and home support services.

Stroke rehabilitation

A stroke occurs when blood flow to the brain is interrupted or reduced. Brain cells can die within minutes, making stroke a medical emergency where time is critical. Emergency medical services (EMS) providers are often the first point of contact for stroke patients. ED physicians and nurses are then responsible for recognizing stroke symptoms, completing a diagnosis, and collaborating with the team on treatment options.

Following this critical care, stroke patients are often transferred to a stroke rehabilitation unit where they receive rehabilitation treatment. This treatment helps patients regain independence and improve their quality of life following a stroke. Rehabilitation should start as soon as possible after a stroke, and informed decisions about rehab should be made quickly. The rehabilitation team includes doctors, nurses, physiotherapists, occupational therapists, speech and language therapists, clinical/neuropsychologists, dieticians, and social workers.

The rehabilitation process involves addressing specific impairments caused by the stroke, such as weakness or difficulty walking, as well as restricted social participation and overall quality of life. Treatment is personalized to the patient, taking into account their comorbidities, views, and preferences. For example, speech and language therapy can help with functional communication, reading comprehension, and writing. Psychological interventions or antidepressant medication may also be needed to address common psychological problems that can impede recovery.

More than two-thirds of stroke survivors in the U.S. receive rehabilitation services after hospitalization, and high-quality basic medical care can benefit all stroke patients. Good communication and shared decision-making with patients and their families are key to this high-quality care.

Frequently asked questions