Crittenton Hospital Medical Center Primary Stroke Center. Cesar D.Hidalgo, MD. Stroke Program Medical Director

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1 Crittenton Hospital Medical Center Primary Stroke Center Cesar D.Hidalgo, MD Stroke Program Medical Director

2 290 bed all-inclusive medical center 500 physicians 54 medical specialties full scope of inpatient, emergency and surgical care to more than 40,000 patients annually 2

3 Residents from Wayne State University School of Medicine specializing in: Family Medicine Internal Medicine Ear, Nose and Throat Transitional Year Residency Program Oakland University School of Nursing Endowed Professorship in Nursing Support for our new program focused on relationshipbased care in nursing excellence Rochester College School of Nursing RN to BSN Program for nurses 3

School of Nursing Endowed Professorship in Nursing Support for our new program focused on

4 4 290 Licensed Beds 21 ICU Beds 20 Psych Beds 11 Pediatric Beds 24 Rehab Beds 32,000 ER/PUC Visits Orthopedics Mother/Baby Hyperbaric Chambers Interventional/Cardiac Surgery Program Cancer Program Sponsored by American College of Surgeons Commission on Cancer Primary Stroke Center Therapeutic Hypothermia Accredited Chest Pain Center

Interventional/Cardiac Surgery Program Cancer Program Sponsored by American College

5 The Joint Commission Certificate of Distinction 6/24/2011 Re-Certification July 2, 2013 Comprehensive stroke focused program Trained in stroke care Individualized care of the Brain Attack Coalition and guidelines to meet stroke patients needs Stroke care based on recommendations by the AHA/ASA Collection of hospitals stroke-treatment performance data. Use of data to assess and continually improve quality of stroke care for stroke patients Foster better outcomes

patients needs Stroke care based on recommendations by the AHA/ASA Collection of hospitals stroke-treatment

6 CVA - Discharged Primary Diagnosis Number of patients Year Patients Linear

150 140 130 120 110 100 90 80 70 60 50 40 30 20

9 Door-Needle Time Since 2011 Door-Needle Time Present % Door-Needle Time * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Initiatives Mock Drills tpa Task Force EMS to CT Charge Nurse Role Perfect Serve Stroke Alert (6/2013)

2011 2011 2011 2011 2011 2011 2011 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2012 2013 2013 2013 2013 2013

10 Emergency Medical Services 15 Transport agencies in Macomb and Oakland Counties. CHMC receives approximately 500 ambulance transports each month. 55% of all EMS transports result in admission to the hospital. Average 29,000 ED visits per year. Quarterly EMS Manager meetings communication with process improvements in the field to hospital. Pre-Hospital education offered to EMS providers 12 lead EKG interpretation Stroke Education Pediatric Airway ACS, ACLS, PALS

55% of all EMS transports result in admission to the hospital. Average 29,000 ED visits per year.

11 Waterford Twp FD Rochester City FD Independence Twp FD Addison Twp FD Bruce- Romeo FD Oakland Twp FD Oxford FD Brandon Twp FD Crittenton Hospital Rochester Hills FD Star EMS Shelby Twp FD Auburn Hills FD Community EMS Alliance EMS Washington Twp FD

Brandon Twp FD Crittenton Hospital Rochester Hills FD Star

12 Emergency Medical Services- Always Connected Innovation with Mobile Application ER Status Communication/Operations Geomap

14 14

15 Radio EMS Report to ED Cincinnati Stroke Scale Last known well time Actual weight upon arrival Expedites head CT scan

17 CT/Lab Order to Results ED - CT and Lab Order to Results 1/1/13-7/1/2013 Goal < 30 Minutes Minutes CT Labs CT 0 Avg CT min Avg Lab min 2013 TPA Patients

20 15 10 5 39 38 20 20 35 25 38 17 40 16 14 13 26 18 26 15 43 28 21 17

18 Minutes Stroke Alert (6/1) 44.6 min ED - Door to Needle Goal < 60 Minutes Door to Needle Walk-in Avg = 90 EMS Avg = 52.5 Total YTD Avg = TPA Patients

19 Received Commission on Accreditation of Rehabilitation Facilities (CARF) 2010 for Stroke Specialty Re-Certified June 2013 Only 1 of 2 certified programs in Southeastern Michigan Assurance to persons seeking services that a provider has demonstrated conformance to internationally accepted standards. Person-focused standards that emphasize an integrated and individualized approach to services and outcomes. Management techniques that are efficient, cost-effective, and based on outcomes and consumer satisfaction.

conformance to internationally accepted standards.

20 11/18/11 Dr. Andrew Xavier, Vascular Neurology Topic and Description TBA 5/21/12 Community Stroke Education Deb Miller,RN,PT 9/12/12 Stroke Prevention & Carotid Arterial Stenosis, Samer Kazziha, MD, Cesar Hidalgo, MD 9/15/12 Stroke Symposium 11/13/12 Stroke Prevention, Cesar Hidalgo, MD 1/16/13 Stroke - Cerebrovascular Accident is no Accident, Cesar Hidalgo, MD 4/15/2013 Rochester Athletic Center Open House Just Move - Stroke Education & Prevention Deb Miller, RN,PT 4/17/13 Stroke Rehabilitation, Christopher Schoenherr, MD 5/30/13 Stroke Awareness Chrysler Tech Center, David Bauer, MD, Glenn Garwood, Cesar Hidalgo,MD, Bernie Hung Monthly CHED One Stop Screening Mobile App and website information (recently awarded Interactive Advertising Competition Award for Outstanding Website)

Hidalgo, MD 9/15/12 Stroke Symposium 11/13/12 Stroke Prevention, Cesar Hidalgo, MD 1/16/13 Stroke - Cerebrovascular Accident is no Accident, Cesar Hidalgo, MD 4/15/2013 Rochester Athletic Center

21 INDICATIONS FOR POSSIBLE TRANSFER OF ISCHEMIC CVA PATIENTS TO COMPREHENSIVE STROKE CENTER 1. Awakening strokes 2. Patients with contraindication to IV-TPA, e.g. recent surgery or bleeding in non-compressible site, full anticoagulation, pregnancy 3. Lack of response to IV-TPA 4. Large strokes in patients outside of IV-TPA time window Presupposes demonstration of clot in proximal intracranial or extracranial artery, and significant ischemic penumbra (radiologic or clinical) in order to avail of mechanical thrombectomy

ACUTE STROKE PATHWAY

ACUTE STROKE PATHWAY THERE IS A NEED FOR STATEWIDE STROKE SYSTEM OF CARE ALL MISSISSIPPIANS SHOULD BE ABLE TO ACCESS NEW PROTOCOLS FOR STROKE TREATMENT JOINT EFFORT WITH EMS, PHYSICIANS, HOSPITALS AND