Thestroke network is modeled on Alabama’s groundbreaking trauma network.
· Thegoal is to coordinate the most appropriate care for stroke patients statewide.
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BIRMINGHAM,Ala. – Modeled on its successful trauma response system, the AlabamaDepartment of Public Healthwill partner with the Universityof Alabama at Birminghamto improve a similar system for improved response to stroke across thestate. This pioneering effort is a five-year statewide quality improvementinitiative that aims to transform the acute stroke care system by coordinatingprehospital and inter-facility emergency stroke care.
The TraumaCommunications Center Coordinated Severity-Based Stroke Triage projectis funded by a $2.5 million, five-year grant to UAB from the NationalInstitute of Neurological Disorders and Stroke,one of the NationalInstitutes of Health.
“The projectis focused on helping EMS providers identify patients with severe strokeand getting them to the appropriate medical facility, exactly as our traumasystem functions,” said Toby Gropen, M.D., the James H. Halsey Jr., M.D.Endowed Professor in the Departmentof Neurologyand director of the UAB Comprehensive Neurovascular and Stroke Center.“The system will coordinate with each of the six EMS regions in Alabamato provide each patient with the right care, at the right place, at theright time.”
In2014, ADPH, the Alabama Trauma Communications Center, Alabama’s emergencymedical system regional agencies, along with hospitals and EMS providersacross the state, established the AlabamaTrauma System.The ATCC is a statewide system that constantly monitors the status of everytrauma hospital in the state, allowing patients to be routed to the mostappropriate facility. In 2017, the same agencies activated the AlabamaStatewide Stroke System, to provide earlyrecognition and routing of patients with stroke symptoms to the neareststroke center.
“Alabama,under the guidance of ADPH, has a history of innovation in creating statewidesystems to ensure that patients are sent to a hospital that is best suitedto provide the necessary care, first in the field of trauma and then instroke,” Gropen said. “The SBST project will build upon that model, usingAlabama’s existing Trauma Communications Center to triage patients tothe most appropriate stroke center.”
“Acute strokesystems of care should emulate trauma systems, which deliver the full rangeof care to all injured patients by means of organized, coordinated effortsin defined geographic areas,” said Stephen Wilson, State EMS director,ADPH. “Just as trauma systems have proven ability to save the lives ofthe most severely injured patients, we should have a stroke system ableto provide care to patients with the most severe strokes.”
Gropen saysthe right place could be the local hospital, depending on the severityof the stroke and the most appropriate medical response. It could alsoinvolve triage from the field directly to an advanced stroke center. Underother circumstances, patients may be initially triaged to a nearby strokecenter and then transferred to a higher-level center. In all cases, theproject will coordinate the care provided to patients with severe stroke,and importantly, the project will work with regional EMS directors andproviders, along with hospitals throughout Alabama, to tailor the localimplementation to the needs of each region.
The projectwill employ several measures to determine its effectiveness. It will comparethe proportion of patients encountered by EMS providers with suspectedcases of large vessel occlusion who are treated with mechanical thrombectomybefore and after implementation of TCC-coordinated SBST. Mechanical thrombectomyis available only in advanced stroke hospitals.
Investigatorswill also assess the broad public health impact of TCC-coordinated SBSTby examining the reach and effectiveness of the intervention, includingany differences by race, ethnicity and population density. They will examinethe ease of implementation and ability to sustain the model in varioussettings.
A final aimof the project will be to assess stakeholder perceptions of the intervention’sfeasibility, appropriateness and acceptability and to identify barriersto and facilitators of the intervention’s implementation.
“This five-yearproject will allow assessment of both the public health impact and the‘how and why’ of implementation of an innovative acute stroke care model,”said Steven Stringer, State Stroke System coordinator for ADPH. “Advancedtherapies for stroke are not available at every hospital in the state,leading to racial, socioeconomic and rural disparities in access to potentiallylifesaving treatment.”
The projectwill implement a phased rollout of TCC-coordinated SBST across Alabama’ssix EMS regions, lending itself to analysis of health processes and outcomesbefore and after the intervention in each region.
“This project,if successful, can serve as a model for how the trauma system infrastructurethat already exists in other regions and states can serve as the basisfor a more integrated and effective system of emergency stroke care throughoutthe United States,” Gropen said.
Currentlyonly two hospitals in Alabama are designated as Level I hospitals for stroke:UAB Hospital and Southeast Health in Dothan. There are 26 hospitals designatedas Level II and 39 as Level III hospitals.
The projectis supported by the National Institute of Neurological Disorders and Strokeunder award number R01NS117813.
The TraumaCommunications Center Coordinated Severity-Based Stroke Triage projectwas launched July 15, 2020.
Known forits innovative and interdisciplinary approach to education at both thegraduate and undergraduate levels, the University of Alabama at Birminghamis the state of Alabama’s largest employer and an internationally renownedresearch university and academic medical center; its professional schoolsand specialty patient-care programs are consistently ranked among the nation’stop 50. Learn more at www.uab.eduand www.uabmedicine.org.