Stroke and the Need to BE FAST

When it comes to treating stroke, initiating care ASAP, especially at a certified stroke center, can greatly improve the trajectory for survival and recovery. Regulatory bodies and other third parties have taken note of the stoke care at UConn Health, which has maintained the distinction of “primary stroke center” from The Joint Commission since first earning it in 2014.

This month, two of the nurses behind the UConn Health Stroke Center‘s success, Jennifer Sposito (clinical coordinator) and Brooke Medel (patient navigator) describe what makes UConn Health so effective at stroke care and tell you what you need to watch for in order to BE FAST, act quickly, and recognize this medical emergency.

(Jennifer Sposito, Brooke Medel, Carolyn Pennington, Chris DeFrancesco, December 2021)


Chris: When it comes to stroke, it’s likely you’re aware of the need to BE FAST. Now today on the Pulse, we’ll talk about what’s going on while that clock is ticking, how to minimize disability from stroke, and what’s effective when it comes to recovery.

This is the UConn Health Pulse, a podcast to help you get to know UConn Health and its people a little better, and hopefully leave you with some health information you’ll find useful.

With Carolyn Pennington. I am Chris DeFrancesco. Stroke, of course, is a medical emergency, and prompt care, especially at a certified stroke center, can make all the difference.

Carolyn: And the UConn Health stroke team has a system in place to give patients the best chance to not only survive a stroke, but also to resume their lives with minimal disruption.

Two members of that team are with us today. Jennifer Sposito, UConn Health stroke program clinical coordinator, and Brooke Medel, the stroke program’s clinical patient navigator. Thank you both for joining us. Now, the stroke program at UConn Health has received a number of recognitions and accolades lately. Why is that so important for the patients, Jennifer, to know that?

Sposito: Thank you for having us today. So we have grown throughout the years from being not designated as a stroke center, in 2013, and then in 2014, we became a primary stroke center. Then through the years we’ve been increasing our quality and winning awards for our quality and care and patient excellence. And we have been lucky to win the Gold Plus Target Stroke Honor Roll Elite Award for five years, which is the earliest we’ve been able to receive this award. It just shows our dedication to patient excellence and care and their quality, and how much we really care about making sure the stroke patients have everything that they need.

Carolyn: And that’s a lot of work behind the scenes to earn these recognitions. How has the team changed over the years in order for you to win these awards?

Sposito: Sure. So when we were first beginning our journey, it was myself, Jennifer, the stroke coordinator, as well as Dr. [Sanjay] Mittal, our stroke medical director. And we were able to get us a designation by The Joint Commission as a primary stroke center. Then we were able to add different members to our team. So we added a neurointerventionalists, Dr. [Ketan] Bulsara, who’s also a neurosurgeon. We also added a neurointensivist, Dr. Gracia Mui, who works in our neuro ICU. We have neuro radiology. Dr. [Leo] Wolansky is here now, and we also have different members like Dr. [Abner] Gershon, who’s our second thrombectomy provider, as well as different vascular neurologists that have joined our department as we’ve grown. So we really grew from this little tiny stroke center to this very large, robust, provider-centric stroke center. From that, we were able to add Brooke to our team as our stroke patient navigator, and it’s fabulous because she’s able to focus on all the patient care through the continuum. So we’re very, very lucky with our growth.

Chris: Let’s talk a little bit about — Jennifer, you mentioned the thrombectomy and I’d like to get in a little more detail about that when we talk about Dr. Bulsara and Dr. Gershon, but — let’s talk a little bit about the two of you, your role in this. You’re both RNs. Brooke, why don’t you explain a little bit about your role as the patient navigator?

Medel: Thanks again for having us. So my role as a stroke nurse navigator is after a patient has a stroke, their whole life turns around. This event just changes their lives, and they leave the hospital, but their symptoms are still there. I’m that blend from inpatient to outpatient and that person to help provide any resources, additional education, or just support for the patients that they need. I meet them at their outpatient neurology appointment if they continue their care through here, us at UConn. I run a support group to help provide extra support for the patients and/or their families that may need it during a difficult time. And I’m that filter to see what else they might need. If they need rides to their appointments, I give a referral to our social worker. If they need help getting medications, I work with whoever I can to help get them those resources that are really key to living their best life after having a stroke. Our team does a fantastic job — before they leave the hospital — to set everyone up for success. I just make sure things don’t fall through the cracks, or if, for instance, things change, their insurance gets dropped or a different life event happens, I’m there to make sure that they stay on that correct path.

Chris: Now, Jennifer, you are the stroke program clinical coordinator.

Sposito: Correct.

Chris: Talk a little bit about what your role is in all this.

Sposito: My role here at UConn is vast. I am kind of the gatekeeper for everything to make sure our stroke program is running well, efficiently. And it goes anywhere from making sure that the stroke alerts are running really smoothly for when the patients come into our emergency department, making sure that the patients have all their metrics, making sure the ICU is running really well, all the way to our stroke unit staff members, because we have multiple stroke units here in the hospital. In addition, I’m heavily involved with all the education for all of our providers, our nurses. Every single staff member that actually works here gets education on how to recognize stroke and then what to do next, so I coordinate a lot of that. And then I work closely with all of our doctors to make sure we have different community outreach events, because the public as well needs to know about what to do when they’re having a stroke and when to come into the hospital. In addition, I’m really kind of the gatekeeper as well for making sure when The Joint Commission comes, we’re having a really successful visit when they come assess our program for becoming a stroke center. So that’s my role in a nutshell.

Carolyn: You mentioned the problem sometimes of identifying a stroke. It can be hard for patients and some providers, right?

Sposito: Correct. We actually do so much education that our staff is really great at recognizing stroke. We have the BE FAST acronym. If you haven’t heard it, it stands for “balance” or coordination trouble; your “eyes,” you might have some vision trouble or trouble seeing; F is for “facial droop”; A is for “arm” or leg weakness on one side of the body. You have “slurred speech” or trouble speaking for S; and then the T for “time.” And we do a lot of education about atypical signs of stroke as well. Maybe you’re dizzy, maybe you’re not feeling well. You have a terrible headache, worst of your life. So our staff members at the stroke center are really heightened to make sure that they are aware of these symptoms and what to do next. And yes, unfortunately we’ve had some patients come to us in the stroke clinic and say to us, “Thank you so much for taking care of us, but unfortunately at this outside hospital, we weren’t recognized, and we just wish we had come to a stroke center, like UConn, where we could have been taken care of in such a great way that we are now.”

So when we hear those stories, they fuel us to spread educational awareness everywhere. We do a stroke conference every year for the state of Connecticut and even outside now that it’s a WebEx, and we want people to be aware of the symptoms for all different kinds of patients, because what we want people to know is that you could have a stroke at any age. You don’t have to be elderly, like people might think. We’ve had stroke survivors, unfortunately, 20s, 30s, 40s, people are having strokes a lot younger than maybe previous —

Carolyn: Why is that?

Chris: Do we know why that is?

Sposito: We don’t. There’s some literature out there and studies, but people are definitely having stroke younger. So we tell everyone, if you are having these symptoms, don’t ignore them, come into the hospital right away.

Carolyn: And why is that so important, to act quickly? Because you do hear those sad stories where people just ignored the symptoms. And then of course their disability is worse.

Sposito: The most important thing I can say is that time is brain. Every two minutes that goes by, 2 million brain cells are dying. And that’s a lot of different brain cells, and that is your memory, that’s your ability to walk, to talk, all these different functions of your body, and the disability can be so devastating. So with time is brain there’s certain interventions that can be done in a timely manner. For example, we have IV thrombolytics that could be administered, but only within the first three-to-four-and-a-half hours. So it’s very timely. You want to see the symptoms, call 911, and come in, because three hours goes very, very quickly. And, in addition, we have an advanced procedure here called thrombectomy, but that can only be done within 24 hours for select patients. So again, time is brain. You want to save as many brain cells as possible and come in quickly.

Chris: I do want to talk a little bit more about what happens when you sound the stroke alert and what are the things that UConn Health can offer, like the thrombectomy and other things. But before we do that, just because I don’t want to run out of time, is, Brooke I wanted to ask you about what happens after we do all these interventions. Now you’re out of the hospital. Now you’re getting ready to try to get back to your life. What are some of the things that UConn Health patients are benefiting from coming here for that phase?

Medel: Absolutely, so depending on their level of disability, they might need to go to an acute rehab to get rehab, or they might be able to get it in our lovely outpatient center as well. We provide physical therapy, occupational therapy, as well as speech language pathology, to tailor to whatever the patient needs, whether they need to learn how to walk again, learn how to brush their teeth, learn how to speak and swallow, whatever they might need. We are here to give them that support if they need it.

From there, recovery is endless. I mean, once a stroke survivor, always a stroke survivor. And it’s just, like I said before, learning how to be your new best self. It is amazing how much progress you can make. It’s hard for the patients to see it in that moment, but I’m fortunate enough to see that growth. I get to contact patients when they leave the hospital about a week out. And for anyone that gets any type of intervention here at UConn, I get to contact them around three months out too. And I promise you, they don’t understand how quick things can change, but when they put in that hard work, amazing things can happen. It’s beautiful to watch.

Chris: And the survivors group that you facilitate, you kept that going through WebEx over the course of the pandemic, so that, that never really took a break, right? That’s been a continued resource?

Medel: Absolutely, because support is, if anything, needed more during those times when you’re more isolated and stuck at home with COVID or worried to get it yourself. So that support is always provided. We’re currently again, just meeting online briefly until the next wave hopefully it goes down and we could be safe and meet again in person. But I’m here to provide that support however I can. All our stroke patients have access to my personal work cell phone number and I’m their support whatever hour they need me.

Chris: Fantastic.

Carolyn: And I’m sure within the group, they support each other, right? Do they?

Medel: It’s beautiful. They’ve made some great relationships. They’ve sent me pictures of Jenn and they’ll send us pictures, them going out to dinner together.

Carolyn: That’s great.

Medel: It’s amazing, the relationships they can build, because it’s kind of nice, someone that understands you or has a similar struggle, because if you haven’t gone through it, you can sympathize, but you can’t empathize. So having that actual connection with someone that is on your level, it’s a whole different type of relationship.

Carolyn: That’s wonderful.

Sposito: One thing I wanted to mention from what Brooke was saying with COVID happening is that patients are at increased risk of having blood clots, which increases your risk of stroke and heart attacks. They’re more hypercoagulable. So we want people to understand COVID makes another layer of concern, because if you’re having these BE FAST stroke symptoms, you really want to jump on it because maybe you’re having COVID and that’s the reason why you’re having the stroke now or heart attack. So we want you to recognize it.

Chris: All right. So, Jennifer, what happens when there’s a stroke alert?

Sposito: We work really closely with our EMS providers as well. So Peter Canning helps us get some education out to them, and we ask EMS to call a stroke alert as soon as the patient’s on the field and on their way to us. They call an early stroke alert, so we’re waiting for them at the door, the entire stroke team, the emergency department, we’re all there for you. And we get a quick bracelet and registration and whip right to CT scan. We don’t stop. We go straight there and we get your imaging. That’s important, so you get your quick care, since time is brain. Once you’re in CT scan, the neurology team will assess you and make the decision for that clot busting medication, the thrombolytic. And then most of the time the TPA is given right there in the CT scanner. So that saves us a ton of time and helps us, you know, with these quality awards, because we’re able to give this so quickly.

Chris: All right. We’re just about out of time, but I want to talk about the thrombectomy real quick before we go. That’s one of the interventions some people are candidates for, Dr. Bulsara does it, Dr. Gershon does it as well. So talk a little bit about what’s happening with that.

Sposito: So this is an advanced procedure that not all hospitals can do. We can do it here at UConn. We’re one of the very few in the state that can do this advanced procedure. And what happens is, we whisk the patient straight to the hybrid OR, which is something that not everybody has. And basically you’re bringing the services to the patient, because we can do the intervention there, and if the patient needs open neurosurgery, they can keep the patient right there on the table. So it’s really, really interesting that we have this, and great for the patients. And what thrombectomy is, is they go in through the groin or the wrist, and they snake a catheter up into the brain and pull that clot out that’s causing the stroke, or put a stent in or some medicine. We’re very excited about that. We’ve been doing that since 2017. And we recently got surveyed from The Joint Commission to become a thrombectomy-capable stroke center, which we passed with flying colors. So this is an amazing accolade for us and something that we’ve been working on for years.

Carolyn: And it has to be so much better for the patient to have these different options and much more likely to survive, or at least have fewer disabilities.

Sposito: If you have UConn, you can get everything right here. You don’t have to be shipped to another hospital. You can have all of your care in one place, which is quicker for you. It improves recovery, because outcomes are really dependent on how quickly you get them. So it’s really wonderful we can do all this here for our patients.

Chris: Right. And like you said, time is brain. So thank you both for joining us. That is the time we have, I’m going to make sure to put in the show notes some more information about the stroke program and a famous video that we made, what, a couple of years ago now, where you had a patient come back in and he promised his nurse that when I get better, I’m going to come in and I’m going to dance with you. One of my favorite videos that, Carolyn, your team has done here, and it’s a great, inspiring thing to share. So we’ll make sure we have that link in the show notes as well.

But that is our time for today for nurses, Jennifer Sposito, and Brooke Medel — Jennifer, the stroke program clinical coordinator, and Brooke, the stroke program’s clinical patient navigator, thank you both for being here — and also for Carolyn Pennington, I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Be sure to subscribe so you can catch us next time, and please share with a friend.