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Hospital’s Stroke Treatment Exceeds National Guidelines

— Not much keeps Peggy Kennedy down. In her six years on the job at an Old Town Starbucks, she’s never called in sick. A couple of Tylenol and she’s good to go. But as she worked the register on June 26, a strange feeling came over her and she had to sit down. Her perfect work attendance streak would soon be over.

"I could no longer take people’s credit cards or cash," she said. "My right arm went numb." The 57-year-old Alexandria native quickly realized she was having a stroke and asked a co-worker to call 911. Her quick response, coupled with a well-coordinated process between Alexandria City’s Fire and EMS and Inova Alexandria Hospital, spared her from a lifetime of disability or possible death.

Peggy experienced the most common type of stroke in which blood flow to the brain is cut off by a clot in an artery. Fast treatment with a clot-dissolving drug known as tissue plasminogen activase, or tPA, can minimize or reverse the devastating effects of this type of stroke, but only if given within three hours. National guidelines call for tPA to be administered within one hour for best results. For patients like Peggy, every minute that ticks by with a clogged artery brings the potential for more damage; hence the saying, "Time is brain."

Thanks to a fast response from Alexandria’s Fire and EMS and their skilled field assessment of her condition, Inova Alexandria Hospital’s stroke team was notified and ready before Peggy arrived. "I was amazed … they were waiting for me to roll through those doors," she said. Little did she know, we’d been perfecting our stroke response for a long time.

Certified in 2005 as the area’s first Primary Stroke Center, Inova Alexandria Hospital is dedicated to committing the resources needed to quickly diagnose and treat stroke patients using evidence-based treatment protocols. We offer a multidisciplinary rapid response stroke team, a dedicated stroke lab and a computed tomography (CT) scanner right in the Emergency Department. We cross-train with Alexandria’s EMS and provide their department feedback on every stroke patient they transport. It’s continual process improvement for all of us.

Late last year, we took that process even further. Using "Lean" methodology that emphasizes customer value with minimal waste, we reevaluated every step in the treatment process to eliminate redundancy or unnecessary steps. We trimmed our stroke protocol by more than half, from 16 steps to just six. As a result, we’ve seen our "door to tPA" times reduced from an average 151 minutes to well under the 60 minutes called for in national guidelines. In fact, Peggy’s door-to-tPA time was 39 minutes. Just three hours after her stroke, she was back to her regular self. A mere four days later, she was lounging oceanside on her planned beach vacation.

"I can’t stress how awesome an experience it was, even as scared as I was," Peggy said. "They made me feel safe and secure, like everything was going to be OK — and it was."

Make sure you know the signs of stroke. Read more at www.stroke.org.