Kimberley Wesley, a nurse at Gwinnett Medical Center, runs a stroke patient through the visual gaze portion of the National Institute of Health stroke scale. The test helps assess damage caused by a stroke.

On average, someone suffers a stroke in the United States every 45 seconds. It’s the third-leading cause of death and the major
cause of long-term disability in the nation.

Knowing that quick response and proper treatment can make a difference, the Gwinnett Hospital System is prepared to deliver excellent care. Its two hospitals, Gwinnett Medical Center and Joan Glancy Memorial Hospital, earned the Gold Seal of Approval for stroke care in March.

“We did it,” said Pam Garland, RN, MN, CCRN, CNRN, manager of the center for neuroscience and one of the driving forces behind Gwinnett Hospital System earning Primary Stroke Center Certification from the Joint Commission on Accreditation of Healthcare Organizations. “We knew that we had a good stroke program and that we were already following a lot of the national guidelines, so we figured why not be recognized for it? Going through the certification process made us take a closer look at everything we do and helped us improve.”

A 20-member, multidisciplinary stroke team oversees the program; including Drs. Carl Buchanan in the emergency room, neurologist Yazan Housammi and Marshall Nash, director of stroke studies.

“Nurses, radiologists, lab techs, case managers, OTs, PTs and rehab specialists are all part of the team,” said Susan Gaunt, RN, MS, CCRN, stroke program coordinator. “These are the process people who make the orders and pathways so that care for stroke patients is a seamless operation.”

When someone calls 911, the emergency medical technicians know the protocols to check for stroke symptoms. If they call a stroke alert, the patient is seen by an emergency room doctor within 10 minutes and is then rushed for a CT scan. If the patient
is a candidate to receive TPA (clot-buster medication), he or she receives it.

“TPA has to be administered within three hours of the onset of symptoms, and it offers the potential for minimizing deficits and improving patient outcomes,” Gaunt said.

Once stabilized, the patient moves to a neuroscience unit which includes multiple levels of care — critical, medium and acute — for all brain abnormalities (injury, aneurism, stroke). Garland developed the unique, one-stop shopping unit for neuroscience
care five years ago, patterning it after cardiac units in hospitals in Ohio and Arizona.

“I always loved learning about the brain.” Garland said. “It’s an interesting and unpredictable creature. If something goes wrong with it, it has a huge impact on people’s lives. Everyone’s brain is different, so everyone’s stroke is different, but our level of response and care needs to be consistent.”

A model neuroscience unit
Garland jumped at the chance to put the unit together.

“My background was in ICU, so when they offered me the opportunity to create a neuroscience unit, I told them I wanted all the patients. We’ve been very pleased with this model and other hospitals have come to study it,” she said.

All nurses are stroke certified and cross-trained within the unit.

“One of the advantages of having all patients is the seamless transition between levels of care, so nothing falls through the cracks,” Garland said.

“Neuroscience symptoms can be very subjective and it’s sometimes difficult to tell if there’s been a change on paper.

“Here, an acute care nurse can easily call on the critical care nurse who cared for the patient previously for a second opinion or further clarification. It’s very beneficial to have critical care backing up acute care.”

Another advantage: Gaunt believes that the stroke research conducted at the hospital leads to a high level of staff enthusiasm.

“We’re one of the top enrollers of patients in neuro-protective agent studies for the country, and because of our certification, we’re likely to do even more research,” Garland said.

Research means that Gwinnett Hospital System’s stroke patients get more attention and education, and that the staff is working with the latest treatments and theories.

Community awareness and prevention education is a growing part of Gwinnett’s stroke program.

“Gwinnett is a young county with a small stroke population,” Garland said. “We see about 350 cases a year, but as the opulation ages and people become aware of the excellence of our program, those numbers will increase and we plan to be ready.”