stroke pandemic care

Stroke Center Experience During The Pandemic – Silver Linings, Discoveries and Combating Brain Drain!

Demands of COVID-19 have robbed us of time to connect with colleagues and share experiences and practices. That’s why, over the last few months, we’ve reached out in various forums to stroke program leaders and coordinators around the country to connect and talk about their COVID-19 experience. We learned of many shared challenges, discoveries worth keeping and new ways to combat pandemic “brain drain.” Read more to see if you can relate!

Stroke colleagues have reported different experiences with staffing during COVID-19.  Early in the pandemic, some hospitals sent stroke staff home to work, or to work in areas that had the greatest need. Others were furloughed. During initial surges, some stroke staff were overwhelmed while the same teams in non-surge areas with few stroke patients were looking for work. Entire teams – stroke coordinators, CNSs, data specialists, managers – went virtual initially, and came back onsite as needed or as comfortable. Early staff deployments resulted in data collection gaps and performance improvement interruption. Some teams are now blended at home/onsite and some are back onsite with limitations in the number of team members that can meet together in a conference room. There are ongoing concerns with staff shortages should schools close.

Across the nation, stroke patient volumes that decreased in the early months are reported to have rebounded. While some centers managed to maintain door-to-treatment times as new safety measures were put into place, others struggled and reported improvement over time. Other volume trends include an increase in walk-ins; patients arriving outside of the window for treatment and fewer stroke mimics and mild stroke or TIA symptoms. More recently, EMS reports that patients in the field are more reluctant to come to the hospital due to limitations on family accompanying them and visitation restrictions.

A common theme across all of our conversations was that all stroke centers had to rapidly modify triage and code stroke processes to protect patients and staff. Many used, or are using, virtual clinician consultations for “code strokes,” for monitoring COVID patients receiving alteplase and for follow-up visits in clinics, IP rehab and SNFs.

One reported struggle has been obtaining NIHSS’s at smaller sites with fewer resources. We learned of a video available that shows stroke neurologists providing tips and tricks on doing the NIHSS remotely and, our colleague, Michelle Whaley, MSN, CNS, CCNS, ANVP-BC, presents the role of the RN at the bedside during the telestroke consult. Dr. Pat Lyden from Cedars Sinai leads the discussion (you may remember him from the original NIHSS training videos). Here is the link to this video:

Some Stroke Support Groups now meet on Zoom with mixed reported results; some survivors and caregivers love it; others are challenged with technology. Some support groups have grown during this time, perhaps showing the need to connect during times of isolation from others. If patients and caregivers can better manage the technology (ZOOM), there may be huge benefits in the future by eliminating the need to travel, park and find meeting rooms.

During the pandemic and during Stroke Awareness Month, many leaders reported reaching out to media outlets to help educate the public that it was safe to come to the hospital and to reinforce the signs and symptoms of stroke. Some tried virtual lectures for the public.

We know selfcare and balance has been difficult during the last several months for all of us. Finding the best and safest new ways to operate required a lot of brain power and was challenging both physically and mentally – nothing was hard wired or automatic and the brain power needed often manifested itself in extreme tiredness. But those of us in the stroke world are resilient and we eventually found a variety of positive methods of self-care including relaxation strategies/meditation, exercising/working out, learning something new, taking on home projects, focusing on good nutrition, connecting with nature and modifying our work environment at home. Some organizations have even offered staff-designated space for employees to relax, attend meditation sessions, listen to soft music, get snacks, etc. during their shift.

Silver linings were found in this pandemic cloud! Stroke nurses report training non-neuro nurses in COVID units on neurological assessments. Wide adoption of tele-platforms helped stroke quality/PI teams and neuro/stroke rounding groups successfully convert to virtual settings. In general, teams report liking the efficiency provided by virtual meetings – they can still interact, for the most part “face-to-face,” on Microsoft Teams or ZOOM platforms and they don’t have to drive to an in-person meeting at another campus!

Virtual meetings and telemedicine visits in the post-acute/discharge phase are most likely to stick post-pandemic. Some barriers still need to be broken down – technology availability, and access and/or ease of use. Patients have widely-reported challenges with access and the capability to use needed technology. Front line staff are hampered by corporate firewalls, software incompatibility and shortages of webcams and headsets.

The pandemic has surely tested all of us. And we have found that we, as teams and as organizations, can be nimble. We can use our collective brain power to innovative change and do it, relative to pre-COVID times, at lightning speed! Let’s not lose that!