By Don Finley
The San Antonio Express-News
SAN ANTONIO, Texas — Only two years ago, San Antonio’s medical community was embarrassed and frustrated that the city had no hospital certified to provide emergency care for stroke patients — unlike other large Texas cities that had several and many small cities with at least one.
That was then. As of last week, San Antonio was home to more stroke centers — eight — than any other Texas city except Houston, which also has eight. And with two more Methodist Healthcare System hospitals here pending approval, San Antonio is likely to surpass Houston within weeks.
On Thursday, University Hospital became the eighth local facility to win stroke certification from the Joint Commission, the national accrediting body for hospitals. Austin and Dallas each have four, and Fort Worth has three.
“I think that what we had was a wake-up call, and we answered that wake-up call with fervor,” said Eric Epley, executive director of the Southwest Texas Regional Advisory Committee on Trauma and chairman of its stroke committee. “This shows the dedication of our health care systems — Baptist, Methodist, University, and to some extent all the other health care systems that have participated in the development of a regional stroke system.”
To be certified, hospitals must put in place stroke protocols, many of them designed to make sure stroke patients can be rapidly assessed and given a powerful clot-busting drug, tPA, if they’re eligible. That requires that some specialists, in particular, neurologists, be available at any hour, although some hospitals have used remote links to neurologists in other cities to achieve that requirement.
University Hospital joins five Baptist Health System and two Methodist hospitals awarded stroke certification. They make up the heart of a local emergency stroke system in which paramedics in the field can scramble stroke teams as they’re bringing in suspected stroke patients.
Some thought University Hospital should have been the first certified, rather than the last. In many cities, it falls to the local teaching hospital to provide emergency stroke care because of the availability of medical residents and paid faculty.
But at the time, University Hospital was unable to come to an agreement with neurologists at the University of Texas Health Science Center and broke up its acute stroke team. Because of overcrowding, the hospital was closed to medical emergencies such as strokes more often than not, and the neurologists said a lack of patients made it financially unfeasible to be on call around the clock.
A new chairwoman of the health science center’s neurology department, Dr. Robin Brey, made stroke care a priority, said Nancy Ray, chief nursing officer and associate administrator of University Hospital.
“Getting stroke certification is much more than the presence of the people on call,” Ray said. “It’s adhering to a very strict set of standards and protocols. And that’s mostly physician-driven, with some nursing support.”
Brey said three neurologists in the department with an interest in stroke care, led by Dr. Lee Birnbaum, have agreed to be on call around the clock, and she is in the process of recruiting two others.
“Being on call, being within 30 minutes of the hospital 24 hours a day, is quite a burden when you think about it,” Brey said. “We want to add two additional stroke neurologists so that I wouldn’t expect these three faculty members to do this forever.”
The next step in the local stroke care system is a “comprehensive” stroke center designation developed by the Texas Department of State Health Services. St. Luke’s Baptist Hospital, the main Methodist Hospital and University Hospital are expected to apply for that advanced designation, administrators have said.
Copyright 2010 San Antonio Express-News