CRMC designated a Primary Stroke Center

Dr. Mark Tedford works with stroke patient Tyree Daniel as nurse Kelli King looks on.

By Michelle Price
Special to the UCBJ

COOKEVILLE – Upper Cumberland residents no longer have to look to the major metropolitan areas for stroke care as Cookeville Regional Medical Center (CRMC) is now certified as a Primary Stroke Center. 

CRMC was recently awarded the Joint Commission’s Gold Seal of Approval® and the American Heart Association/American Stroke Association’s Heart Check mark for Advanced Certification for Primary Stroke Centers. The Gold Seal of Approval and Heart-Check mark represents symbols of quality from their respective organizations.

“The Joint Commission gives accreditation to hospitals that have demonstrated a certain level of proficiency in the treatment of stroke patients,” said Dr. Mark Tedford, CRMC neurohospitalist. “A lot of that is in the acute treatment of stroke patients, like what happens in the emergency department. A fair bit is what happens during their admission and during discharge as well.”

CRMC spent nearly two years on reworking systems of care in the hospital to get better, faster and improve outcomes necessary to meet the metrics and demonstrate themselves proficient at a high level to attain this certification.

The work that went into perfecting the stroke protocol, aptly named ‘Code: Stroke,’ involved bringing in partners from all stages of patient care, including dispatchers and emergency services crews, triage nurses and physicians in the emergency department, lab technicians, physical therapists, and case managers who work with discharge planning. 

“We learned just how many hands go into creating something like this,” said Tedford. “We had to have 30 ducks in a row from the time the patient first developed symptoms until the time they are discharged to be able to really give them the best care possible.

“I knew it was complicated but having to sit in a room with 30 or 40 people once a month and figure out how these pieces were going to fit together just reinforced to me how big an effort this is across so many service lines in the hospital.”

Achieving this Primary Stroke Center status has changed the way that CRMC treats stroke patients allowing more to remain at CRMC instead of transferring to other facilities.

“I think Cookeville as a community or even the UC region has been wanting this for some time,” said Buffy Key, CRMC senior vice-president of quality and operations. “We’ve had a lot of stroke patients come to our facility that we’ve been able to treat somewhat and then transfer them to a higher level of care, but it’s so nice to have the providers that we have, and not just the physicians but like Dr. Tedford said, the community members, the EMS and just everybody being involved in one common goal and that is to recognize the stroke, treat it if we possibly can because as the stroke folks say, ‘time is brain,’ and so every second counts.” 

“Time is brain” is the main factor to remember when it comes to stroke. The longer you wait to seek medical help from the onset of symptoms, the less chance you have of making a complete recovery.

Often people aren’t sure what symptoms to pay attention to. CRMC uses the acronym BEFAST to look for stroke symptoms:

B – Balance – if you are having problems with your balance or if you are having new sudden onset of dizziness that feels like you just can’t quite stay on balance

E – Eyes – sudden loss of vision or sudden changes in vision in one or both eyes

F – Facial droop

A – Arm weakness

S – Speech difficulty – difficulty in speaking or the lack of ability to speak at all

T – Time – time is brain. Every second counts in a stroke

Don’t wait if you experience any of those symptoms or a combination of them. 

Historically patients who experience these symptoms might lay down thinking that the symptoms would go away. The clock is ticking. If the symptoms don’t go away, then the patient is likely going to be outside the treatment window by the time they seek help.

“For any acute stroke, the sooner we can begin treatment the better, and the odds of successfully treating a stroke actually decrease by the minute,” explained Tedford. “So, in general, if we can get to a patient within two to three hours of when their symptoms first started, that gives us the best odds of helping them improve.

“There are some treatments that we can sometimes offer some patients out to 12 or 24 hours even, but that is a small minority of patients. So, for the majority we really like to get to them within a couple of hours of when the symptoms started.”

The two most important things to remember if you think you are experiencing stroke symptoms are to mark the time that the symptoms started and to call 911 immediately.

“It is definitely better to call 911 and not just try to get into your physician,” said Amie Burton, stroke program data abstractor. 

If you are experiencing symptoms of stroke, do not attempt to drive yourself to the hospital.

“Studies have shown that even though you have to wait at home for the ambulance to show up, a patient arriving by ambulance gets through the emergency department so much faster that, despite that initial delay, you are still more likely to receive treatment for an acute stroke and have a better outcome,” shared Tedford.

It’s important to tell the dispatcher, when you call emergency medical services, that you think that person’s having a stroke. Use that terminology, if the patient is having any of those symptoms, because that signals urgency to the dispatcher. 

The protocol ensures that the dispatcher notifies the EMS crews and the hospital that the patient is a potential stroke victim. Once that code is paged out, the staff knows what is going on and the emergency department is already starting their stroke protocols before the patient even arrives at the ER.

“The ER has been amazing, but the inpatient folks have been as well because we also offer the Code Stroke service if the patient is inhouse and has the signs and symptoms of stroke,” added Key. “It doesn’t happen very often but it can and so we alert the same kind of highly acute system.”

After achieving this level of prestige for their stroke care, CRMC is looking at how to improve other services they provide.

“Our goal is to be better tomorrow than we are today and that will always be our goal,” Key added.“We are pleased to receive this two-year certification from The Joint Commission and American Heart Association/American Stroke Association,” said Paul Korth, CEO at Cookeville Regional. “The teamwork it takes to receive this type of designation is commendable, and I want to thank all the staff, physicians and leadership for their hard work to make us a Primary Stroke Center. This certification provides us with the opportunity to highlight exceptional stroke care to our community as well as to continue striving to advance our care even further.” 

CRMC ‘stroke team’ nursing staff take great care of stroke patients like Tryee Daniel, 71. From left to right: Savanah Allen, Mary Ragland, Cassidy Gardner, Kelli King, Valerie Hamm, Dr. Mark Tedford, Tyree Daniel and Jennifer Workman

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