The phone number is easy to remember - but who's calling it?

A few posts ago, we looked at the hospital behavior after a stroke patient is hospitalized. And you have seen postings about how hospitals often take patients more seriously if they arrive via ambulance.

But who's calling for an ambulance ride? Here's an interesting look at how race and sex may influence who calls an ambulance for stroke symptoms:

With an average age of 71, half of the stroke patients were women and almost 70 percent were white. Almost 20 percent were black, 8 percent were Hispanic and 3 percent identified as Asian.

How much priority will you get when it comes to saving your life?

This week's theme: Taking stroke patients seriously. Sadly, we are not always taken seriously.

This is written in kindness - my life was saved by health professionals in a hospital. But we've all seen the other side in hospitals - the hurry-up-and-wait phenomenon. And in my own personal observations, transportation is a big issue for hospitals.

So it's not a big surprise that in those cases in which a stroke patient needs to move to a stroke center, the transfer is actually no faster than driving yourself:

Training stroke patients for the just-in-case scenario

Photo from Thomas Hawk via Flickr

Learning is generally a good thing.

Ever been hospitalized? If so, it's likely you went through a discharge process, received some instructions and signed some papers. In my experience, most instructions are semi-helpful at best. Now, here's an idea that might be an upgrade for in-hospital instructions - educating stroke survivors helps them spot another stroke faster:

Stroke survivors who receive extensive stroke education are much more likely to recognize symptoms of another stroke and seek immediate treatment, a new study shows. ...

Are hospital patients with stroke 'hiding in plain sight?'

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We're all told: Time is brain. And in a recent posting, even the newly developed tools to battle strokes work better when there's no delay.

So, it's a little distressing to find that time is still a problem - for patients who are already in a hospital. Even delays in imaging to determine best treatment. You'd think if the patient was already in the hospital, that would not be a problem.

But it is.

Read about recent research showing that imaging is delayed when a stroke strikes within a hospital:

Do stroke patients already in hospital get less treatment?

You'd think that if you're already a hospital patient, you'd get quicker care for an in-hospital stroke vs. having a stroke elsewhere.

Not necessarily, sadly. After years of visiting and sitting with hospital patients, I can see why. You see delays in almost everything. And in a recent Canadian study, it was found that in-hospital stroke patients wait longer for care:

The study results showed that in-hospital patients waited an average of 4.5 hours from the time symptoms were recognized to undergo computed tomography compared with 1.3 hours for patients brought to the ED.

"To me that's a shocking difference," said Dr Saltman.

About 29% of in-hospital stroke patients met the "benchmark" best practice of getting thrombolysis within 90 minutes of symptom onset compared with 72% of patients coming from the community, said Dr Saltman.

In addition, the in-hospital group was less likely to receive thrombolysis (12%) than the group admitted after having a stroke outside the hospital (19%), even if they were eligible for this intervention, she added.

In-hospital patients stayed longer in the hospital (17 days vs 8 days), were more likely to be discharged to a rehabilitation facility (40% vs 32%), and were less likely to be sent home (35% vs 44%).

This speaks volumes for the need for advocates for stroke patients, especially if they are having speech or physical difficulties while in the hospital.

Is it true in the United States? Add your own experiences below.

Earlier hospital release: Good news, bad news

I can't decide whether this story is good news or bad news - Ireland could free up 24,000 hospital beds by letting stroke patients out early:

The report found that 54% of stroke survivors, or more than 3,000 people each year, could benefit from a policy of ‘early supported discharge’.

This approach to rehabilitation allows patients to return to their own homes more quickly and intensive treatment is given in the home for a number of weeks. According to today’s report, this approach would require a substantial increase in the resourcing of community therapists (physiotherapists, occupational therapists, and speech and language therapists), community nurses and other community care above current levels in Ireland.

However, savings from the reduced cost of acute bed days could fund this increase in resourcing.

On one hand, hospitals are not healthy places. Lots of sick people and germs are present. You might or might not sleep well in a hospital. Family members are strained.

Yet, hospital is the place to be if you need it. Health professionals, equipment, treatment options are in the same place.

So I could see if this plan is executed well for people who would benefit more out of the hospital, AND services become available in the patient's own home: Good idea.

If executed not-so-well, releasing people who still need the services of the hospital just to save money in short terms (but would increase cost in long terms): Not a good idea.

I could see this sort of effort happen in the United States, too, with the ongoing debate about health care costs. So worthy of watching.

No closing times for strokes

Ever been in a hospital over a weekend? Hospitals are famous for making people show up before dawn during weekdays for a medical procedure so they can sit and wait for hours - and virtually shutting down on Saturdays and Sundays.

Now, from England, is a story on how an elderly man was turned away from King’s Mill Hospital because stroke unit shut at 6 p.m.:

Elderly stroke victim John Mallalieu was turned away by a Nottinghamshire hospital because it was too late on a Friday afternoon.

The ambulance carrying the 89-year-old from Caunton to King’s Mill Hospital in Sutton-in-Ashfield was diverted to City Hospital in Nottingham, where he remains in intensive care.

The incident was a timely reminder of the additional problems facing patients who need attention at weekends.

Did this patient choose to have a stroke so close to 6 p.m.? Certainly not.

Hospitalized stroke patients receive worse care

I've written before about the value of showing up in an ambulance for better care. And you'd hope that once you're in the hospital, you'd be in excellent care. Now, some recently released statistics indicate that stroke patients already in the hospital receive worse care:

Stroke patients receive better care if they have their stroke outside the hospital than in the hospital. These worrisome findings come from a study based on data from the American Heart Association's Get With the Guidelines program.

"Maybe the emergencies we are least prepared for are the emergencies that happen in our very own backyard," Ethan Cumbler, MD, said here at Hospital Medicine 2013. ...

Defect-free care, defined as the proportion of patients who received all of the achievement-measure interventions for which they were eligible, was significantly worse for in-hospital stroke than for community-onset stroke... .

"The gap in defect-free care was larger than I expected," Dr. Cumbler told Medscape Medical News.

This also might show the value of being an advocate for someone in the hospital.

Time is key - even in small towns

My stroke did not happen in a big city or at a huge hospital. But God still arranged my care by medical professionals who knew what to do.


An interesting article about a “telestroke” technical tool at smaller hospitals:

Not all hospitals have the most up-to-date technology for evaluating people who may be having a stroke. But emergency rooms with access to a rapid-response stroke center via a consultation system known as “telestroke” can minimize brain damage caused by stroke, according to Stroke: Preventing and Treating “Brain Attack,” a new report from Harvard Medical School.

When stroke symptoms occur, quick action is vital. Getting to a hospital emergency room, preferably one that specializes in treating stroke, is crucial. To prevent brain cell death, treatment is most effective if it starts within an hour of the start of the stroke. One of the main clot-dissolving drugs, tPA, must be given within a few hours after symptoms appear.

Internet Stroke Center at Washington University

Yesterday's post mentioned the Internet Stroke Center at Washington University in St. Louis. It's also connected with Barnes-Jewish Hospital, which is next door to the university's medical school.

The Internet Stroke Center offers resources for patients and families, including basics on recognizing stroke symptoms, caring for stroke survivors and reducing stroke risk. There's a link to the latest stroke news. It's a good Web site to note during Stroke Awareness Month.

One of the more disappointed stories, from MedWire News, starts this way: "Only a fifth of people who suffer a stroke recognize the event as an emergency and go urgently to hospital, research reveals." That means, of course, four out of five people who suffer a stroke do not recognize the event as an emergency and go urgently to a hospital. We need to do better. Much better.

Here are the symptoms:

• Sudden numbness of the face, arm, or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Even if you suspect that's going on - to you or someone else - get to some help fast. As stated before, a false alarm is better than a funeral.

Being several days out of my effort to post to this blog almost every day and keep it active, I've found it gets easier every day and discovered some fascinating people and additional resources. And on that note, thanks be to God.