Stroke care at UCLA Health is set up for speed in a remarkable system of integrated care. In a conversation with Dr. David Liebeskind, Professor of Neurology and Director of the Stroke Center, he notes that the emergency phone call for symptoms that may be a stroke activates health care teams throughout the hospital, and puts in place nurses, doctors, scanners and technicians at every step. The stroke neurologist is notified when the EMTs and ambulance teams are first contacted in the field. The stroke team meets the patient in the emergency department and the entire emergency department staff is readied so that there are no delays in evaluation and treatment. Brain scanners, CTs and MRIs, are opened and immediately ready to image the patient. The scans are read by the stroke team in real-time, from the scanner, and the treatment plan is launched—often directing a patient to a radiology interventional suite to remove a clot, or to neurosurgery for a possible brain hemorrhage. An important modern twist with advanced brain imaging is that the MRIs, coming off in real time, can tell the team if a seemingly mild stroke is in fact in a position to get much worse later. This means that a patient can be given specific therapies, rather than having to adopt a “wait and see” response. The Neuro-Intensive Care unit neurologists are alerted along with this response, and are ready for the sensitive management of the patient after these initial treatment decisions. This is all happening before the patient even comes out of the MRI or CT scanner.
An important aspect of this time-sensitive care is that it is invisible to the patient. A person at home may call 911 because they have trouble moving one side of their body, and within minutes they are being examined in the emergency room gurney as they move to the scanners. As teams prepare for multiple aspects of care, this process may appear “linear” to the patient and their family: a patient moving through a highly trained system along a single route. In fact, stroke at UCLA Health involves multiple parallel teams moving together to minimize the time needed for any treatment decision and management. In Stroke Neurology, Chronos is a competitor that is beaten by rapid, parallel and highly trained multidisciplinary care.