June 24, 2019 by John Fernandez
B.E.S.T. Responders Tend to Stroke Patients When Time is Critical
To say that time is critical for stroke patients coming into the ER is an understatement. The team of healthcare professionals at Baptist Hospital, working closely with doctors and nurses from the Baptist Health Neuroscience Center, need to gather facts quickly to determine if a patient can go into imaging, get clot-busting drugs or undergo life-saving surgery.
And they have to get the patient ready and treated within a very tight timeframe that cannot exceed 24 hours from the onset of stroke symptoms.
The nurses that are the primary point of contact between the patient and the neurologists on duty are members of B.E.S.T. (Baptist Emergency Stroke Team) — part of the first-response unit that takes action once a patient arrives at Baptist Hospital. This group has so effectively cared for stroke patients that additional B.E.S.T. teams are planned for other Baptist Health hospitals.
Andrew Waisbrot, R.N., patient care manager, Baptist Health Neuroscience Center, and staff nurse Jessica Kolostov, R.N., are two members of B.E.S.T. that are always on call throughout the day at Baptist Hospital as stroke patients come in, either by ambulance or driven to the ER by relatives or friends.
Gathering Vital Information
“We gather as much information as possible, either from the patient, or from fire-rescue if the patient is unable to give us information,” explains Mr. Waisbrot. “We’re also pushing the patient to get a CT scan so that we can have the most up-to-date information for the neurologist to make the decision of giving the patient life-saving medication called tPA right away.”
The frenzy that sometimes accompanies the stroke response can be overwhelming to the patient and family members.
“All of this happens within like a five-minute span or so,” he says. “It is very fast sometimes and it can be frightening to patients seeing how fast we move, but the point of us moving so fast is to save the brain.”
Strokes are the fifth cause of death for adults in the United States and the leading cause of disability, according to the American Stroke Association. The most common strokes are “ischemic,” which occur as a result of an obstruction within a blood vessel supplying blood to the brain.
Many people are aware of stroke symptoms, such as a face drooping, arm weakness or speech difficulty. But often strokes hit without a witness, making the B.E.S.T. teams work much more challenging.
24-Hour Timeframe for Treatment
“Maybe a person’s having a stroke and nobody’s around them to witness it,” says Ms. Kolostov. “That’s a big thing for us since that tPA medication that we give is time sensitive. The cap is about four and a half hours from onset of symptoms. For it to be effective and work, we really need to know that information. Much of the time, we work off the last time someone saw the patient normal or well.”
If patients arrive within 4.5 hours of onset of stroke symptoms, they can be treated with tPA medication, a clot-busting solution used to treat ischemic strokes — the most common type of stroke. The blood clot can cause serious complications, such as brain swelling, and can lead to considerable disability or death.
If they arrive up to 24 hours after the onset of symptoms, patients who are no longer in the window for tPA can undergo “mechanical thrombectomy,” in which doctors remove blood clots using a device threaded through a blood vessel.
Under more ideal circumstances, paramedics “give us a preliminary score — called the F.A.S.T. score and that helps determine the severity of the stroke that then allows us to activate the proper personnel to treat such stroke” says Ms. Kolostov. “So once the patient arrives, we meet the patient in the trauma room and determine if they’re stable to go straight for a CT scan.”
Comprehensive Stroke Center
More than four years ago, Baptist Hospital was designated by the Joint Commission, which accredits U.S. healthcare organizations, as a “Comprehensive Stroke Center.” This designation means that a facility has the necessary resources — including advanced imaging capabilities and neurologists, neurosurgeons and interventional neuroradiologists — to treat the most complex stroke cases.
Both Mr. Waisbrot and Ms. Kolostov say the work of B.E.S.T. can be very challenging. But it’s mostly very rewarding to see their quick and precise fact-gathering process yield successful treatments in that critical 24-hour timeframe.
“It’s a huge reward — after seeing a patient come in and how affected they are by the stroke — to see them improve from the treatment that we’re able to provide here and see how quickly they get better,” says Ms. Kolostov. “And when you see that improvement, the family is there and they’re so grateful. That’s what makes us feel good. “