Big Push for Stoke Center of Excellence Leaves Other Diagnoses Behind

We recently became a Stroke Center of Excellence, meaning that our small community facility receives all the potential strokes in the area based on pre-hospital criteria. We also have an EHR, which is very cumbersome in the acute ED setting. The process is working smoothly, with suspected strokes receiving CT scans within minutes of entering the ER. Thankfully, the majority of these CTs are negative for bleed and the stroke "symptoms" are related to other disease processes. Meanwhile, other patient populations are being left behind because of the high influx of pre-hospital "stroke" patients. Chest pain patients wait far to long to be treated, severe abdominal pain patients’ care is delayed because of the resources required to care for patients are being limited. Patient care should be based on presentation, past history and medical judgment. To show this in detail, we recently received a patient who was found unresponsive in his vehicle. He was brought in as a suspected stroke; weakness, nausea and vomiting, hypertension, slurred speech. While being triaged and placed on the monitor, he was found to have multiple rhythms. His rhythm strip went from profound bradycardia in the 10’s and 20’s to AIVR in the 70’s to runs of VTach. The ER physician wanted a CT right away, the nurses wanted Cardiology right away. Cardiology showed up, slipped in a temporary pacer and all symptoms resolved. The patients pressure stabilized, he became awake and alert, was oriented and conversive with normal speech. The lesson we learned is that not all patients who present with "stroke" signs and symptoms are stroke patients, and still need to be treated as individuals with nursing judgement. Needless to say, his EHR waited until after he was stabilized. It is difficult to have the record reflect real-time treatments, which is one of the rationales for having EHR.

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