Crittenton Hospital Medical Center
Primary Stroke Center
Cesar D.Hidalgo, MD
Stroke Program Medical Director
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290 bed all-inclusive medical center
500 physicians
54 medical specialties
full scope of inpatient, emergency and surgical
care to more than 40,000 patients annually
• Residents from Wayne State University School
of Medicine specializing in:
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Family Medicine
Internal Medicine
Ear, Nose and Throat
Transitional Year Residency Program
• Oakland University School of Nursing
– Endowed Professorship in Nursing
– Support for our new program focused on relationshipbased care in nursing excellence
• Rochester College School of Nursing
– RN to BSN Program for nurses
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290 Licensed Beds
21 ICU Beds
20 Psych Beds
11 Pediatric Beds
24 Rehab Beds
32,000 ER/PUC Visits
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Orthopedics
Mother/Baby
Hyperbaric Chambers
Interventional/Cardiac
Surgery Program
Cancer Program
Sponsored by American
College of Surgeons
Commission on Cancer
Primary Stroke Center
Therapeutic Hypothermia
Accredited Chest Pain
Center
The Joint Commission –
Certificate of Distinction
• 6/24/2011
• Re-Certification July 2, 2013
– Comprehensive stroke focused program
– Trained in stroke care
– Individualized care of the Brain Attack Coalition and
guidelines to meet stroke patients’ needs
– Stroke care based on recommendations by the AHA/ASA
– Collection of hospitals stroke-treatment performance data.
– Use of data to assess and continually improve quality of
stroke care for stroke patients
– Foster better outcomes
Number of patients
CVA - Discharged Primary Diagnosis
250
240
230
220
210
200
190
180
170
160
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
233
203
194
Patients
Linear…
2010
2011
Year
2012
Door-Needle Time
Since 2011
Door-Needle Time
2011 - Present
350
33%
300
250
200
150
Door-Needle Time
100
50
0
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2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2011
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2013
2013
2013
2013
2013
2013
2013
2013
2013
2013
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Initiatives
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Mock Drills
tPA Task Force
EMS to CT
Charge Nurse Role
– Perfect Serve Stroke Alert (6/2013)
Emergency Medical Services
• 15 Transport agencies in Macomb and Oakland
Counties.
• CHMC receives approximately 500 ambulance transports
each month.
• 55% of all EMS transports result in admission to the
hospital.
– Average 29,000 ED visits per year.
– Quarterly EMS Manager meetings – communication with process
improvements in the “field to hospital”.
– Pre-Hospital education offered to EMS providers
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12 lead EKG interpretation
Stroke Education
Pediatric Airway
ACS, ACLS, PALS
Waterford
Twp FD
Rochester
City FD
Independence
Twp FD
BruceRomeo
FD
Addison
Twp FD
Oakland
Twp FD
Oxford FD
Crittenton
Hospital
Brandon
Twp FD
Rochester
Hills FD
Shelby
Twp FD
Star EMS
Auburn
Hills FD
Washington
Twp FD
Community
EMS
Alliance
EMS
Emergency Medical ServicesAlways Connected
• Innovation
with Mobile Application
•ER Status
•Communication/Operations
•Geomap
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Radio EMS Report to ED
•Cincinnati Stroke Scale
•Last known well time
•Actual weight upon arrival
•Expedites head CT scan
CT/Lab Order to Results
ED - CT and Lab Order to Results
Goal < 30 Minutes
1/1/13-7/1/2013
60
60
59
55
50
45
Minutes
40
43
39
38
35
40
38
35
30
25
20
15
26
25
20
20
17
16
14
13
28
26
18
15
CT
Labs
CT
21
17
23
18
17
18
15
10
11
5
6
0
Avg CT- 20.8 min
Avg Lab - 32.2 min
2013 TPA Patients
ED - Door to Needle
Goal < 60 Minutes
360
Stroke Alert (6/1)
300
Door to
Needle
44.6 min
Walk-in Avg = 90
EMS Avg = 52.5
Total YTD Avg = 55
Minutes
240
180
120
90
60
71 81
68
41
55
74
74
66
60
30 29
0
2013 TPA Patients
32
25 29
• Received Commission on Accreditation of Rehabilitation
Facilities (CARF) 2010 for Stroke Specialty
• Re-Certified June 2013
– Only
1 of 2 certified programs in Southeastern Michigan
– Assurance to persons seeking services that a provider has demonstrated conformance to
internationally accepted standards.
– Person-focused standards that emphasize an integrated and individualized
approach to services and outcomes.
– Management techniques that are efficient, cost-effective, and based on outcomes and
consumer satisfaction.
• 11/18/11 – Dr. Andrew Xavier, Vascular Neurology Topic
and Description TBA
• 5/21/12 – Community Stroke Education – Deb Miller,RN,PT
• 9/12/12 – Stroke Prevention & Carotid Arterial Stenosis,
Samer Kazziha, MD, Cesar Hidalgo, MD
• 9/15/12 – Stroke Symposium
• 11/13/12 – Stroke Prevention, Cesar Hidalgo, MD
• 1/16/13 – Stroke - “Cerebrovascular Accident is no
Accident”, Cesar Hidalgo, MD
• 4/15/2013 – Rochester Athletic Center Open House – “Just
Move” - Stroke Education & Prevention – Deb Miller, RN,PT
• 4/17/13 – Stroke Rehabilitation, Christopher Schoenherr,
MD
• 5/30/13 –Stroke Awareness – Chrysler Tech Center, David
Bauer, MD, Glenn Garwood, Cesar Hidalgo,MD, Bernie
Hung
• Monthly – CHED One Stop Screening
• Mobile App and website information (recently awarded
Interactive Advertising Competition Award for Outstanding
Website)
INDICATIONS FOR POSSIBLE TRANSFER OF ISCHEMIC CVA
PATIENTS TO COMPREHENSIVE STROKE CENTER
1.
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4.
Awakening strokes
Patients with contraindication to IV-TPA, e.g. recent surgery or bleeding
in non-compressible site, full anticoagulation, pregnancy
Lack of response to IV-TPA
Large strokes in patients outside of IV-TPA time window
Presupposes demonstration of clot in proximal intracranial or extracranial
artery, and significant ischemic penumbra (radiologic or clinical) in order
to avail of mechanical thrombectomy