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Cedar-Sinai Stroke Team

Cedars-Sinai Medical Center

By Taryn Fort

When Cedars-Sinai Medical Center stroke program coordinator and registered nurse Laurie Paletz’s stroke pager went off one day this past fall, she quickly joined her team in the emergency department to assess a patient. As Paletz entered the room, the patient recognized her. “There she is!” the patient shouted.

While Paletz didn’t immediately recognize the woman, she had indeed met her weeks earlier at a senior health fair. Paletz’s team had distributed refrigerator magnets that listed the symptoms of stroke and urged people to act fast and call 911 if they recognize any stroke symptoms.

The magnet helped save the patient’s life. “She [the patient] said she realized she was having a stroke and called 911 because of what she had learned at the health fair and knew she needed to come to the hospital because of the refrigerator magnet,” said Paletz. Today, the patient is a stroke ambassadors in the hospital’s local community.

In this case, Paletz and the stroke team did more than save a life. They saw the impact of local community stroke education accomplished while working toward primary stroke center certification a distinction symbolized by a Gold Seal of Approval™ from The Joint Commission. Certification is based on areas for performance measurement that are eventually reviewed during a surveyor visit. The Gold Seal of Approval™ signals to a hospital’s community that its services have the critical elements to achieve long-term success in improving stroke outcomes.

“We meet so many people in our work and really never know how what we do and what we say will impact someone down the road,” said Paletz, who credits her dedication and inspiration as a stroke coordinator to personal experience with stroke. “Stroke awareness and community outreach and education are more than just my job. I have always felt if we can reach out, educate and help one person, then all of the effort and time is worth it.”

Time is certainly key in stroke. It’s the nation’s third leading cause of death and the leading cause of adult disability. With an estimated six million survivors alive in the US today, stroke is clearly a treatable condition. However, treatment can be time-dependent and people should immediately call 911 when stroke symptoms begin.

The Joint Commission launched its primary stroke center certification program in 2003. It was the first program of its kind in the US to recognize stroke care programs that follow national guidelines and standards to improve stroke outcomes. In early 2006, Cedars-Sinai decided to join the ranks. They began what stroke program director Dr. David Palestrant describes as “a huge undertaking” to becoming a certified primary stroke center. For a hospital as big as Cedars-Sinai — it houses more than 10,000 employees and treats nearly 600 strokes per year — it would take another two and a half years of planning, education and seven tireless people to achieve the goal.

Part Two: Getting Started

Palestrant worked directly with Paletz from the beginning to lead the effort. Their mutual admiration for each other was a plus. Paletz describes Palestrant as "the champion we needed to make things happen." Likewise, Dr Palestrant says he found "the best" in Paletz when it comes to a dedicated stroke coordinator. "It’s crucial for the person in this position to be able to motivate and inspire those she comes in contact with through their passion for stroke care," he said. "Laurie certainly personified this."

They set forth devising a plan to successfully pass what would eventually be an unannounced surveyor visit from The Joint Commission. Their first task was staff buy-in. "In an institution of our size, which is both a mix of private and academic practitioners, a tremendous amount of work was needed to get physician and staff buy-in and education," said Palestrant. "The good thing about certification is that though one may think the stroke care is good in an institution, having bench marks to follow and implementing standardized care really shows where your weakness are and challenges you to come up with ways to addresses the problems; I think this really improves care at the end of the day."

The Cedars-Sinai core stroke team was comprised of seven individuals overseeing the hospital’s stroke program, protocols and clinical practice guidelines. They are required to have eight hours of continuing education before certification is awarded. The core stroke team is also responsible for establishing education programs, acquiring outcomes data and facilitating improvement activities that teach hospital staff about providing the best stroke care possible.

Various and numerous hospital departments are involved and educated about stroke, so institutional support is necessary from the get-go. Hospitals must present at least a four-month track record of stroke data upon first review. "Multiple departments and units land up caring for each stroke patient and we had to work closely with each of these individual areas to ensure that our protocols would work for them respectively, and that quality of care was ensured as the patients moved though each of these areas," pointed out Palestrant. "This involved communication, education and constant feedback."

Read More: Parts 3 & 4, Parts 5 & 6

Find out more about National Stroke Association’s Stroke Center Network (SCN) program!

Questions about SCN can be directed to pmembers@stroke.org or 303.754.0935.

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