South Florida Hospitals Join Trend of Becoming Stroke Centers

State law spurs race for 'stroke center' status


 
 

Patty Pensa | | Wednesday, July 9, 2008


FORT LAUDERDALE, Fla. -- As stroke care advances, hospitals are lining up to create centers to treat these "brain attacks" with as much urgency as they treat trauma patients.

Hospitals are propelled by a 2004 state law that sends ambulances to stroke centers even if another hospital is closer. Florida leads the nation in the number of stroke centers because of the law, the state's large population and older demographic. Palm Beach County has six, Broward County 11.

But not all stroke centers are the same, and it can be hard for patients to know the difference. With neurosurgeons in short supply, some hospitals don't have specialists to handle complications or bleeding strokes. Most are primary stroke centers, which provide baseline care. A few are comprehensive stroke centers with cutting-edge treatment, but patients aren't always transferred to them.

Doctors agree centers are a better approach to stroke care but say care can be inconsistent.

"Every hospital wants the patients," said Joey Bulfin, chief nursing officer at St. Mary's Medical Center in West Palm Beach. "The question is, can you provide the care? If you have to transfer patients out for neurosurgery, it kind of defeats the purpose."

St. Mary's became the county's newest stroke center earlier this year. As a trauma center, the hospital already had neurosurgeons on call and nurses experienced with brain and spinal cord emergencies, which Bulfin said made the transition easier. The hospital wants to be known as a neuroscience center of excellence and plans to become the higher-level comprehensive center.

Some 780,000 Americans have strokes each year and the disease remains the nation's No. 3 killer after heart disease and cancer, according to the American Stroke Association.

Suffering a stroke used to mean paralysis. Little could be done until the clot-busting drug tPA was approved for strokes in 1996. Outcomes hinge on how fast patients seek help: Nine out of 10 stroke sufferers are ineligible for tPA treatment. But combined with surgical advances, some stroke patients today need little rehabilitation.

Dr. Jim Jaffe, a neuro-interventional radiologist, pulls out blood clots using a catheter and surgical tools. His role makes JFK Medical Center in Atlantis the only comprehensive stroke center in the county. Surgical procedures can be done up to eight hours after the onset of a stroke, compared with a three-hour window for tPA.

Jaffe operates on about 35 stroke patients a year, with 70 percent of clots removed and half of patients recovering successfully. Only a couple of patients come from other stroke centers, though more could benefit from the surgery, he said.

"People don't understand what's going on in the stroke community," said Dr. James Goldenberg, medical director at JFK's center. "They expect when they come to the hospital, they will get the latest treatment. There's no way to know that's available."

The Joint Commission, which accredits hospitals, launched stroke certification in 2003. Stroke care is largely about standards. How long does it take to get an image of the brain? How much longer to read that image? No more than 45 minutes combined, according to the standards. Labs must be done in that time, too.

"You're making a decision on how that patient is going to be treated the minute they hit the door," said Jean Range, an executive director at the Joint Commission. In Florida, she added, "there's been much more interest in becoming certified."

About 100 hospitals in the state are stroke centers, and Range said she expects that number to grow. Boca Raton Community Hospital, for example, plans to be certified this year. The hospital's goal is to offer a wide range of services so patients don't have to go anywhere else for care, said Richard Van Lith, chief executive officer.

At Jupiter Medical Center, the loss of patients became a big motivator. Officials said the community wanted the hospital to become a stroke center so patients wouldn't have to travel far for care. Joint Commission certification came in February and by May, the hospital had about 30 stroke patients.

Hospitals routinely handled stroke patients before the concept of a stroke center developed and state law dictated patients would go to the centers. Prior to the mid-1990s, rehabilitation was the main treatment. When tPA -- a drug originally used for heart attack patients -- was approved for stroke, it opened up a world of possibility for stroke sufferers.

Its main drawback: Nine of 10 stroke patients can't get the drug because they don't recognize symptoms early enough.

"Strokes come on in very subtle ways," said Bulfin of St. Mary's. "The community is not familiar with the subtle signs of stroke. They might ignore it for a day or two."

Patty Pensa can be reached at ppensa@sun-sentinel.com or 561-243-6609.




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