Mediclinic’s new multidisciplinary approach to stroke care
Posted on 1 October 2019
To ensure stroke patients receive the right treatment at the right time, Mediclinic’s innovative Stroke Project incorporates a range of expertise.
A stroke is a genuine medical emergency that requires immediate, expert intervention. By bringing the appropriate expertise to bear on each and every patient, by means of a dedicated, multi-professional stroke team, Mediclinic aims to ensure stroke patients have better outcomes, says Dr Melanie Stander, Emergency Medicine Manager: Mediclinic SA.
Mediclinic has embarked on a new clinical pathway approach to stroke cases across all its hospitals in South Africa, she explains, with the aim of standardising the processes required to diagnose and treat stroke patients.
“We know a lot more about stroke today, than we did even four or five years ago,” she says. “There is now a recognised body of international evidence, which demonstrates that patients with strokes who are treated in a standardised and timeous manner – by a dedicated, experienced team of experts from different fields of expertise – have far better outcomes.”
The key, for both patients and the doctors who treat them, is knowing that every minute counts.
It is estimated that the brain uses an average of 20% of the body’s oxygen, and requires a constant supply of oxygen in order to function optimally. When blood flow to the brain is interrupted, whether due to a blood clot or a bleed caused by damage to a blood vessel, this is known as a stroke – and it can have disastrous consequences.
“The longer your brain goes without oxygen, the more brain cells you lose,” explains Dr Daniel Fiandeiro, an Emergency Medicine Specialist at Mediclinic Pietermaritzburg. In fact, a 2005 study in the journal Stroke found the typical stroke patient loses 1.9 million neurons each minute in which the stroke is untreated.
The best defence against large-scale, irreversible brain damage is proper time management, says Dr Fiandeiro. “Knowing when a stroke has occurred, and getting expert help as soon as possible – this helps us to understand the specific stroke at hand, and how to treat it. Early treatment is essential.”
To ensure patients are treated as soon as possible after the onset of a stroke, Mediclinic’s new stroke treatment approach incorporates a few key personnel: ER24 paramedics, a doctor based in the Emergency Centre (EC), a radiologist and a physician or neurologist.
“Many times, bystanders won’t recognise symptoms of a stroke,” says Dr Stander. “This is why ER24 medics are crucial – they need to identify those warning signs and act quickly, pre-notifying hospital staff and moving as fast as possible to get that patient to the EC. Appreciating the need for speed at this stage could be the difference between good outcomes and bad.”
Next step: Mediclinic staff in the Emergency Centre are primed to receive and escalate the patient through triage efficiently. “Different kinds of stroke may present the same, but treatment will vary according to the underlying cause,” says Dr Stander. “So our doctors run a series of tests to determine whether the patient has suffered an ischaemic or haemorrhagic stroke, and prescribe the necessary treatment accordingly.
A radiologist plays a key role here. “To determine the cause and severity of a stroke, we need to perform brain imaging tests,” says Dr Fiandeiro. “Ideally, our radiologists will have been pre-notified and will be on standby, ready to conduct CT scans the moment the patient has arrived.”
The results of these tests will then be examined by a team of doctors, who will decide on an appropriate course of treatment. “The sooner those doctors see those results, the better,” says Dr Fiandeiro. “Unfortunately not all stroke patients require the same treatment – what could benefit one, could potentially harm another. So we have to move quickly, and have to be careful too.”
In years gone by, our treatment options for stroke patients were very limited., says Dr Stander. “Now, we know a stroke does not have to be a death sentence. If we get a stroke patient into the ambulance and into the hospital quickly, and can identify the right treatment at the right time, that person could possibly recover and go on to live a long and healthy life. The faster we move, the more we can do – and Mediclinic is committed to doing as much as we can.”