A simple and inexpensive protocol made it possible to halve the care time for cases with suspected cerebrovascular accident (CVA) at Hospital Geral do Grajaú, in the south zone of São Paulo.
Patients who arrive seeking care at the hospital can be seen in up to 13 minutes and with the diagnosis of stroke confirmed or ruled out in less than 20 minutes. The average service time in public hospitals is 45 minutes.
Velocity refers to two temporal measures adopted in medical practice: the door-to-doctor time (how long it takes between the patient entering the hospital and being attended to by a doctor for the first time) and the door-to-neuroimaging time (related to the time until the imaging exam that can prove the diagnosis of stroke).
The protocol was developed based on an international model, using the metrics of Hospital Geral do Grajaú and which are already implemented by the Sírio-Libanês Social Responsibility Institute, which manages the hospital.
From January to July 2021, the average door-to-doctor and door-to-neuroimaging times at the hospital were 17 minutes and 35 seconds and 31 minutes and 31 seconds, respectively. A year later, from July 2021 to January 2023, they dropped to five minutes and 30 seconds and to 18 minutes and 59 seconds, respectively.
The improvement occurs through the use of a very simple device: a bell. Hospital care teams, from those who are part of the medical team, such as paramedics, doctors, nurses and nursing assistants, and from the administrative part, such as attendants and security guards, are instructed to identify several signs of suspected stroke.
Patients are prioritized and taken to the emergency room or neurologist for care. If the suspicion of stroke is confirmed by the signs shown, the doctor activates a bell that will ring in the computed tomography room.
When the bell rings, the tomography technician finishes the ongoing service and immediately blocks the room to wait for the suspected case of stroke to arrive. Thus, the patient is prioritized.
The implementation of the protocol in other hospitals that serve the SUS in São Paulo or in the rest of the country is total, according to the doctor and hospital superintendent, Andréa Matsushita. “It is a free protocol, the only expense is the bell, and it is the result of a series of actions that were taken at Hospital do Grajaú in which patients with signs of a stroke were prioritized in care”, she explains.
“There is no additional cost for the SUS, the benefit observed in that time after the adoption of the protocol was obtained just by training the hospital teams on how to prioritize the patient”, he says.
Reducing the length of care for suspected strokes is important because, if the diagnosis is confirmed, it is necessary to start treatment as soon as possible to avoid sequelae or even death.
There are two main types of strokes.
Hemorrhagic stroke occurs when a cerebral vessel ruptures. More dangerous, it is also rarer, representing 15% of cases.
Ischemic stroke is the most common (85%) of cases and is caused by the formation of a clot that obstructs blood flow to the brain and, consequently, the arrival of oxygen. As oxygen is essential for the functioning of cells, if ischemic stroke is not treated quickly, it can leave sequelae in the organ.
When ischemic stroke is identified by imaging, the treatment used is a thrombolytic medication, which will dissolve the clot and resume normal blood flow in the area. The faster this procedure is done, the lower the risk of death or development of sequelae.
Since the beginning of the pandemic until now, doctors have seen an increase in stroke cases in younger patients. This is worrying, as stroke can be a highly debilitating disease that may have a high risk of developing other diseases, such as dementia and Alzheimer’s.
Stroke hospitalizations are also a serious public health problem, as they can lead to excessive unnecessary hospitalizations. Stroke is the main cause of hospitalization considered preventable in the country, according to a study.
Hospital Geral do Grajaú is managed by the OSS (Social Health Organization) Instituto de Direcção Social Sírio-Libanês, linked to the hospital of the private network of the same name. The referenced hospital serves mainly the districts of Grajaú, Cidade Dutra, Socorro, Marsilac and Parelheiros, with an estimated population of 1 million inhabitants.
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