Marcus Daly Memorial Hospital has been awarded the 2020 Stroke Hero Award by the Rocky Mountain Stroke Foundation for their exceptional job in stroke care.
A stroke is an interruption of blood supply to any part of the brain and the leading causes of adult disability and death in Montana.
“Stroke is a time-sensitive emergency that requires precise coordination and early, targeted rehabilitation to achieve the best possible outcome for the patient,” said Michael McNamara, secondary prevention specialist at Montana Cardiovascular Health Program, in the award letter to the hospital.
MDMH’s stroke program works to provide a fast response and has built a team with the emergency and rehabilitation departments.
Registered nurse and Director of Patient Care Services at Marcus Daly Memorial Hospital Jen Bush, said strokes can affect a variety of ages, but are more often seen in elderly. She said the key to successful intervention is for people to know the symptoms of stroke and to seek medical help quickly.
“There are a variety of symptoms from altered mental status to inability to talk, altered gaits, things like that are typical,” Bush said. “Based on symptoms presenting we determine whether or not to activate our stroke team.”
MDMH has partnered with Providence St. Patrick Hospital in Missoula through their Providence System Telestroke Program, under their Telehealth umbrella, to have immediate and live access to neurologists. Time is critical and as soon as the stroke team is activated, the TeleHealth stroke cart with a camera is brought in to the patient room in Hamilton. The neurologist at Providence in Missoula can see the patient, do the exam, and interact in real time with the patient, family members, nurses and physicians to determine if the patient is a candidate for medications or procedures.
“It literally happens in minutes,” Bush said. “It is real-time seeing the patient, to make sure [stroke patients] are getting the best care they can get here at Marcus Daly.”
She said “Time is brain,” “Time is outcome” and “every second of every minute counts.”
Emergency Department RN and Intensive Care Unit manager Tom Price said the longer it takes to get healthy oxygenated blood flowing correctly to the brain the more detrimental a stroke can be.
“The longer it takes to get the clot removed or medication that breaks up the clot affects their recovery,” Price said.
The American Stroke Association provides guidelines to recognize stroke symptoms with an easy to remember acronym of BEFAST. Check for a sudden loss of balance, a sudden loss of vision in one or both eyes, or double vision, ask the person to smile and check to see if one side of the face droops and ask the person to raise both arms and see if one arm drifts downward. Check their speech — ask the person to repeat a simple sentence, and check to see if words are slurred or the sentence is repeated incorrectly. Time is critical, if a person shows any of these symptoms, immediately call 911 and get them to the hospital as quickly as possible.
“Calling 911 allows the receiving hospital to get everyone ready,” Bush said. “They can do some preliminary screening in the ambulance and we can activate TeleStroke and get all our key players in to place.”
The Stroke Program at MDMH started with training in the fall of 2018 and it was up and running by January of 2019.
“It took a lot of training because there are hands-on skills that the nurses here have to do for the physician online,” Bush said. “We are continuing to better our process. We constantly ask how can we remove two more minutes, how can we shave off the timeline because every minute we do is better for the patient. In the last year we did 54 activations for people with stroke-like symptoms.”
After the stroke is taken care of in Hamilton or Missoula, the patient then goes to rehabilitation.
“If the patient is from the Bitterroot, they end up back with us,” Bush said. “They receive specialty care from our rehabilitation center. Our ‘Swing Bed’ program is for patients who meet a certain criteria and we provide services to better their everyday activities.”
Rehab helps patients be safe to go home and gives additional days for therapies in caring for themselves and beyond.
Rehabilitation specialists Sarah Mollenhauer, doctorate of physical therapy, and Bill Ownbey, occupational therapist certified hand therapist, were named specifically in the 2020 Stroke Hero Award. A patient sent their names to the Rocky Mountain Stroke Foundation telling her story and touting their dedication and professionalism.
Ownbey said the MDMH Rehabilitation team is patient oriented.
“That means the patient goals drive our therapy,” Ownbey said. “Patients tell us ‘this is what I want to be able to do’ and we make our therapy patient-centered and purposely-driven. Things have to be meaningful for patients to work on, they are a team member also.”
Ownbey said patients progress from learning the initial caring for themselves, towards accesses the community with shopping, driving and using adaptive supports like a wheelchair or cane.
He said the whole team (of occupational therapy, physical therapy, speech therapy and the physician) helps patients with cognitive issues like concentration, organizing and sequencing their day.
“We work with the family to make sure it gets carried over to the home,” Ownbey said. “Goal setting is where we start. To someone with difficulty getting out of bed, rolling to their side is a big deal.”
Physical Therapist Sarah Mollenhauer called Ownbey a great role model.
“I love working with people who have neurological impairments and I definitely am learning from him,” she said. “He is amazing.”
MDMH Rehabilitation Director Pete Dunn said his comprehensive department has made stroke therapy a priority.
“The team is committed and personalize the care that they provide,” Dunn said. “We have a strong team that is patient-centered.”
He praised the stroke team’s efforts and gave a specific, caring example of Ownbey working with a patient who loves the outdoors.
“Bill [Ownbey] problem-solved with the local bike shop to make it so [the patient] can ride on his own now,” Dunn said. “It is an example of Bill motivating a patient.”
Ownbey said that to be successful at rehabilitation you have to be an encourager.
“You have to help people set goals and see the progress,” he said. “Our rehab has a lot of good, encouraging people who know best practice in regaining skills. You have to be an encourager but you also have to know the most current techniques in stroke recovery.”
Ownbey said every person and their recovery is different.
“No two are the same and I have to remind patients not to compare themselves with anyone else,” he said. “There are different strokes for different folks.”