Quality of Care Determines Outcome of Stroke

Vonda Essenburg had a long history of health problems, but her stroke on June 1, 2007 caught her by surprise. She remembers that “foggy” feeling as she struggled to lift a glass of lemonade and quickly realized she needed help.

She called 911 because three digits were easier to manage than the seven required to reach her parents. Although she couldn’t speak very well, she was able to confirm her address. Help arrived and she was quickly transported to the nearest primary stroke center, Spectrum Health Blodgett Hospital in Grand Rapids, Michigan.

Almost a year later, Essenburg, 55, credits her quick response, hard work and the quality of care she received after the stroke for her steady recovery.

“Looking back, I was in terrible shape,” Essenburg said. “I couldn’t talk, couldn’t walk and my thoughts were jumbled. Today, I am doing things that I thought I might never do again.” Essenburg currently attends outpatient therapy sessions at the Spectrum Health South Pavilion.

“My therapist, Kristina, gives me more than I think I can do. I say ‘I don’t think so’ and she always says ‘I think you can’ and then I do it. It’s amazing,” Essenburg said.

Experts confirm that getting medical attention fast is the most important action people should take when they think they may be experiencing a stroke.

“Surviving a stroke is the first step and that requires getting help quickly,” said Dr. Brian Averell, a neurologist with Spectrum Health and Michigan Medical, P.C. “Most stroke survivors will leave the acute care hospital with some level of disability. The greatest healing takes place during the first three months after a stroke, so the care program is critical.”

Blodgett Hospital has been designated a Primary Stroke Center by the Joint Commission. Stroke patients are met by a stroke response team comprised of physicians, specially trained stroke nurses and pharmacists. Acute ischemic strokes, caused by thrombosis or embolism, are often treated with the FDA-approved drug tPA (Tissue Plasminogen Activator). Essenburg arrived in the Blodgett Hospital emergency department well within the critical three hour window needed for responders to administer tPA. She did not receive the drug, however, because it was determined that her stroke was caused by a hemorrhage.

Following her hospital stay, Essenburg went to Spectrum Health Continuing Care Center for inpatient rehabilitation, including physical, occupational and speech therapy services. The center is the only subacute stroke specialty program in Michigan that is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). Nearly 85 percent of the patients receiving stroke rehabilitation through Spectrum Health’s subacute rehab program are eventually able to return to community-based living.

“As a physician, I try to set reasonable expectations for my stroke patients while maintaining their level of hope for recovery,” Averell said. “What I have seen is that, with the right care, some patients who have significant deficits on day one can walk away with minimal disabilities.”

According to the American Stroke Association (ASA), the functional impact of stroke can be improved through rehabilitation that is delivered by a specialized interdisciplinary team. Under the direction of a physiatrist (rehabilitation physician), an interdisciplinary rehabilitation team comprised of nurses, registered dieticians, speech/language pathologists, occupational therapists, physical therapists, social workers and recreational therapists, a comprehensive, integrated approach to care is provided.

Essenburg spent two months at the Spectrum Health Continuing Care Center, receiving therapy every day.

“The nurses and aides were excellent-very skilled and very compassionate. One called me recently just to see how I was doing,” said Essenburg.

Spectrum Health Continuing Care Center staff works closely with stroke patients and their families to create a personalized discharge plan. Once a patient is medically and functionally stabilized, they are discharged to a setting that will provide support and follow-up care. Spectrum Health Visiting Nurse Association, accredited by the Community Health Accreditation Program (CHAP), provides an interdisciplinary stroke rehab program in the home. Spectrum Health has 12 outpatient sites offering community-based therapy following a stroke.

Upon discharge, Essenburg returned to her home and her brother moved in to help with her care. Her parents help transport her to medical appointments, and back and forth to therapy two times a week. She considers her recovery slow but steady and is optimistic for the future.

“It has been hard, and most of the time tedious. I have had to relearn so much,” said Essenburg. “However, I have made so much progress. I have received great care at each step and I have ambitious goals for my future.”

Spectrum Health Butterworth and Blodgett hospitals were the first primary stroke centers in West Michigan accredited by the Joint Commission.

According to the ASA, stroke is the third leading cause of death in the United States with approximately 700,000 Americans suffering a stroke each year. Stroke is also a leading cause of serious, long-term disability. Because prompt treatment is so important to stroke survival and recovery, Spectrum Health encourages people who notice any of the following symptoms in themselves or another person to call 911 immediately:

“FAST” Stroke Symptoms

F: FACE    Uneven smile, facial droop/numbness, vision disturbance
A: ARM & LEG   Weakness, numbness, difficulty walking
S: SPEECH   Slurred, inappropriate words, muted
T: TIME    Time is critical; if you notice these symptoms call 911.

Spectrum Health is a not-for-profit health system in West Michigan that offers a full continuum of care through its seven hospitals, more than 140 service sites and 560,000-member health plan, Priority Health. Spectrum Health’s 14,000 employees, 1,500 medical staff members and 2,000 volunteers are committed to delivering the highest quality care to those in medical need. The organization provided $98.6 million in community benefit during its 2007 fiscal year. Spectrum Health has earned more than 50 national awards during the past 10 years.