The history of Mediclinic’s stroke initiative
Posted on 17 September 2019
Mediclinic hospitals now provide a streamlined, standardised approach to treat and manage stroke patients. Emergency Medicine Manager Dr Melanie Stander explains how this innovative new stroke initiative came about.
“For the past two-and-a-half years, Mediclinic has been involved in a formal project to streamline and standardise our stroke treatment protocols, across all our hospitals. The aim of this has always been to ensure we provide the best stroke care possible, aligned with accepted best practices and the latest clinical research.” Dr Melanie Stander, Emergency Medicine Manager: Mediclinic SA
“Strokes are a significant cause of mortality and morbidity in South Africa,” agrees Dr Stander. “This is why we have renewed our focus on measures and protocols designed to treat stroke patients timeously and effectively.”
A stroke occurs when normal blood flow to the brain is interrupted. When this interruption is caused by a blood clot blocking a major artery, this is known as an ischaemic stroke, and when it is caused by a blood vessel bursting or leaking, experts refer to the condition as a haemorrhagic stroke. These interruptions can lead to rapid, significant cell death within the brain, with lasting and dramatically debilitating effects.
“A stroke is a major medical emergency,” explains Dr Stander. “In the past, a stroke patient wasn’t treated with the same urgency that we apply in the present day. Thanks to an ongoing body of international evidence, we now know patients with strokes who are treated in a standardised and timeous manner, with a dedicated multi-professional stroke team, have much better outcomes.”
Research studies have demonstrated that time is essential in initial stroke care: the sooner a patient is assessed after the onset of a stroke, the earlier medical experts may be able to intervene and prevent further damage to the brain. “Internationally we have a four-and-a-half-hour window in which to determine a patient’s optimal course of treatment – such as if they are a candidate for thrombolysis or not, for example.”
Thrombolysis, or fibrinolytic therapy, involves using intravenous medication to break down blood clots that have formed within blood vessels. This technique has been used with great success in patients who have suffered heart attacks, and recently, doctors have begun to recognise how it can be used to halt the effects of a stroke in certain qualifying cases.
“We don’t treat each and every patient with this technique,” Dr Stander says. “It is highly effective for those who are candidates, but dangerous for those who are not eligible, as it can increase the risk for bleeding.
The key is the speed of the intervention: the later a patient is assessed, the more damage has been done to the brain before doctors have a chance to determine which form of treatment is applicable.
“This is why we have standardised and streamlined our stroke assessment process,” explains Dr Stander. “We now know that certain options of treatments can be highly effective in stroke cases – but only if these patients are received, assessed and treated early.”
Mediclinic Emergency Centres are equipped with easily accessible Stroke clinical pathways, including everything doctors require to document and direct the treatment process. “Strokes present with a variety of symptoms, and it is can be difficult to determine what kind of stroke a patient has had using only a history and physical assessment alone. To determine the best course of treatment we have to go through the same list of clinical checks every time. So streamlining that process makes things quicker and easier for our doctors, and better in the long run for our patients.”
By formalising the Stroke Project, Mediclinic’s aim is to create an integrated model for stroke care across all Mediclinic facilities, which will ensure that all stroke patients are treated timeously in the most appropriate facility to ensure the best possible outcomes.