Subacute Stroke Treatment & Secondary Prevention
In order to optimize patient outcomes it is critical for patients in the subacute phase to be educated in secondary prevention regimens. Regardless of the patient care setting, a systems approach can provide important support mechanisms to ensure that evidence-based practice guidelines are put into practice consistently.
In regard to mortality and morbidity during the subacute phase, the ASA White Paper (source) ( http://www.americanheart.org/presenter.jhtml?identifier=3056504 ) states that “Approximately one third of stroke patients worsen during the initial 24 to 48 hours after stroke onset.” The prevention of deterioration from stroke as well as common complications (myocardial infarction, deep vein thrombosis, pulmonary embolism, urinary tract infections, aspiration pneumonia dehydration and poor nutrition, skin break-down and metabolic disorders) is critical.
Critical progress markers that should be developed in all facilities providing subacute care for stroke include:
- the use of clinical pathways for all patients with a history or suspected history of stroke or transient ischemic events that are based on national guidelines and standards of care
- the use of a standardized discharge packet that educates stroke patients and families on risk factors, medications, stroke warning signs, rehabilitation options and the availability of time sensitive therapy, as well as the appropriate method for activating EMS in their area
- consistent use of standardized protocols that screen for and ensure timely transition from inpatient to appropriate next level of care (i.e. rehabilitation and/or outpatient care) consistent with The Joint Commission (TJC) standards for all patients with a history or suspected history of stroke or transient ischemic events.
The Virginia Stroke Systems Task Force makes the following recommendations in the context of subacute treatment and secondary prevention of stroke:
- A stroke system should use organized approaches (eg, stroke teams, stroke units, and written protocols) to ensure that all patients receive appropriate subacute care.
- A stroke system should adopt approaches to secondary prevention that address all major modifiable risk factors and that are consistent with the national guidelines for all patients with a history or suspected history of stroke or transient ischemic events.
- A stroke system should ensure that stroke patients and their families receive education about stroke risk factors, warning signs, and the availability of time-sensitive therapy, as well as the appropriate method for activating EMS in their area
- A stroke system should ensure a smooth transition from inpatient to outpatient care, including timely transfer of hospital discharge information to the subsequent treating physician and a clear method of appropriate follow-up.