Paul Szmal: We're going to talk about stroke awareness, stroke treatment, warning signs, and all of those associated things with two guests from the University of Rochester Medicine joining us this morning. First off, I want to welcome in Matthew Talbott, he is the Vice President of Medical Affairs and Chief Medical Officer for University of Rochester Medicine, Finger Lakes Health. Morning.
Matthew Talbott: Good morning, Paul.
Paul Szmal: Also joining us this morning is Anne Guerreri, she's a Quality Improvement Analyst in the Performance Improvement Department, also holding an Associate of Science in Respiratory Care Therapy and a Bachelor's in Business Administration and Management. Morning, Anne. How are you?
Anne Guerreri: Good morning, Paul.
Paul Szmal: All right. So, let's get the conversation started here by actually defining and giving a clinical definition to what a stroke is. I think most people, it's like, I kind of get it, but may not be 100% aware of what is actually happening from a medical standpoint. Matt, do you want to take that one?
Matthew Talbott: Sure, Paul. So, if you think of a heart attack where you lose blood flow to the heart, a brain attack is really what a stroke is, is that there's usually a blockage. The major type of strokes is that type of stroke in one of the big arteries that feeds blood to the brain. And when there's a blockage, of course, the brain loses blood and loses oxygen. And then that tissue dies. The other type of stroke, which is less likely, is what we call a hemorrhagic stroke or a bleeding-type stroke. And that's usually when one of those vessels will rupture, rather from an aneurysm or uncontrolled high blood pressure for quite some time, and then the blood gets into the tissue. And similarly, that tissue can not be viable.
Paul Szmal: Now, I wasn't aware of high blood pressure being the possibility of a trigger of a stroke like we're talking about here with the hemorrhagic. Now, I've heard about and know about the aneurysm thing, but that's something I wasn't aware of.
Matthew Talbott: Yeah, so the main risk factors, what we call modifiable risk factors for the clot-type strokes that we try to control are high blood pressure, diabetes, of course, high cholesterol, which is why sometimes what we call primary stroke prevention, we focus on making sure your bad cholesterol is as low as we can get it based on the evidence. But blood pressure over time will increase both your risk of having a bleeding-type stroke, also will increase your risk of having a clot-type stroke or what we call an ischemic stroke. Now, at Geneva General Hospital, and if you want to speak about this part, it's a joint commission-accredited primary stroke center, and it's a New York state-designated stroke center. Those are important accreditations.
Paul Szmal: Very much so, they are, yes.
Matthew Talbott: Our team works very hard to, we have standards to meet with both of those organizations and our team works very hard to meet all those standards. And the Geneva General Hospital has been a recipient of multiple American Heart Association Get With The Guidelines awards.
Paul Szmal: Get With The Guidelines, Ann, can you explain exactly what that is? Because this is actually like a national thing.
Anne Guerreri: Correct. It is. So, there are standards, again, that our team works at striving for. I need a little help here.
Matthew Talbott: Sure. Get With The Guidelines is through the American Heart Association. It's a national benchmark, so whether you're at the Mayo Clinic, Cleveland Clinic, or Geneva General Hospital, if you come in and you're having a stroke, you're going to get the same standardized care.
Anne Guerreri: Talking about stroke this month, in addition to being stroke month, it's very appropriate timing as we just had our recertification joint commission stroke survey, and very happy to announce that when the surveyors come through, as you can imagine, they're always collaborative and focusing on what we call requirements for improvement, so conditions of participation that CMS and the evidence establish that we need to follow. As you can imagine, there's always a few requirements for improvement. We're very happy to report on our most recent survey, we had zero requirements for improvement. So that was really what our surveyor described as a unicorn survey.
Paul Szmal: So when we're talking about Getting With The Guidelines and this program, that actually creates a standard protocol that is followed when a stroke patient comes into Geneva General or to Soldiers and Sailors, one of the other University of Rochester Medicine Finger Lakes Health locations. And it also provides a repository so Ann can enter data. We know what we're measuring, so we know our performance indicators, and if we do fall out on a measure, then we can create a plan where we can correct whatever gap we may have had that led to that opportunity. And I'm reading here that at times a patient may receive something that's called intravenous clot busting therapy. Is this something relatively new or has this been around a while?
Matthew Talbott: This has been around a while, and this is the importance of identification of stroke so that you can timely come to the hospital and get those therapies available at primary stroke centers. So Paul, these therapies that we are able to administer in Geneva and other primary stroke centers across the state need to be administered within four and a half hours of what we call last known well. And that's the last time that a family member or a friend or even the patient is aware that they were at their baseline. So as you can imagine, if somebody goes to sleep, even though there are some newer data coming out and there's just recently adopted guidelines through the American Heart Association and American Stroke Association, we still need patients to get to the hospital as quickly as they can so we can administer these therapies.
Paul Szmal: And I think it goes without saying, Ann, that early detection, knowing the signs that somebody is having a stroke and acting on that immediately, those moments are critical towards what the long-term outlook may be as far as getting into recovery mode.
Anne Guerreri: Absolutely. That's why we've also been going out into the community trying to educate people on what the signs are to look for. So we have an acronym called BFAST that we, it's to help teach those exact symptoms. So like the B stands for balance. The E stands for eyes. So if you have issues with your vision, the F stands for your face. So if you have that facial droop that you hear about, the A is for arms. So like if you put your arm up and you're not able to hold it in place and it drifts down, that's another sign where you have weakness on your right side versus your left side. The S is for the slurred speech. And then the T is for time, because time is a brain.
Paul Szmal: Now do all of these present themselves in a stroke case or could it be that maybe there's a couple of symptoms or is this?
Anne Guerreri: It could be only one of those symptoms or a couple of them. But the importance is any of those, once you recognize them, to get right to the hospital. Because that window of time we have to give that clot bluster is so important. We have such advanced technology in the emergency department and through our partners in radiology these days, Paul, that we can immediately, within usually 15 to 20 minutes, know if there is a clot in one of those major vessels. So I often explain it to patients as if you think of a hose, we need to get the water to where it needs to go. And if the water is not getting to where it needs to go, that's where we lose brain.
Paul Szmal: The neat thing about the University of Rochester Medicine Stroke Program is that it doesn't stop with the immediate care that's necessary for a stroke victim because there's life beyond that. There's rehabilitation, therapy at times, sometimes physical therapy if some motor function is lost. And that's kind of inclusive to the overall care program that you all provide.
Matthew Talbott: It's such an interdisciplinary team, as you mentioned, between our radiology colleagues, our nursing colleagues from the patient care techs in the emergency department, our lab, and then when patients do get admitted to the hospital, typically we'll go down what is our stroke pathway, get an MRI to identify exactly where the stroke occurred, and then work with our partners in rehabilitation therapy, occupational therapy. We have really 360 wraparound ability to care for the stroke patient with our long-term care facilities, our rehab on the outpatient side, even those patients that need to go to strong that may benefit from what we call endovascular therapy. So similar to having a heart cath, now you can do kind of a brain cath. And so sometimes those patients that are not eligible to get that intravenous therapy, they are eligible to potentially get interventional therapy.
Paul Szmal: And if people want to find out more information about the stroke program and the different services that are offered within the University of Rochester Medicine, and that includes preventative screening, you know, checking your diabetic levels, checking your blood pressure, your cholesterol levels, things of that nature, because like you said, these can be determining factors of a higher likelihood. And how do people get a hold of the information on that?
Matthew Talbott: If you go to our website, we have a whole section set up for stroke. So it gives you a little bit of the information we've been talking about, how we're doing with things and what we have set up for outpatients. We do have a stroke program, an outpatient stroke program that's all virtual. They can sign up for that. And then working with our rehab services department. And certainly working with our physician referral network. One of the most important things, of course, is establishing primary care. So all of those risk factors that occur throughout our years are modified as best possible to prevent one from ever having a stroke. The number one risk for having a stroke is having a prior stroke.
