Stroke Program

Program Overview

Hoag’s comprehensive Stroke Program is led by full- time, in-house physicians who specialize in advanced stroke management and intervention, and have developed best practice care pathways for optimal outcomes. As a founding member of the designated Comprehensive Stroke Neurology Receiving Centers in Orange County, Hoag helped pioneer many of the specialized processes and methods to reverse stroke when possible, and to optimize care for stroke patients. The ultimate outcome metric is the patient’s ability to return to a self-sufficient life, an outcome we measure in every patient with a 90-day survey.

Our stroke rescue process starts immediately on arrival with assessment of the patient by our experts, and triage for the most advanced treatment appropriate to the patient’s condition. As part of the stroke team, Hoag’s Emergency Department physicians and staff start the stroke protocol.

In place since January 2008 but continuously updated, the so-called Code 20 process is like a NASCAR pit crew. Upon a stroke patient’s arrival at the ED, neurological assessment, lab testing, and neuro imaging are done within 20 minutes, versus the national benchmark of 30 minutes. Evidence- based use of clot-busting drug treatments, as well as endovascular mechanical intervention when needed, optimizes the chances for stroke reversal.

Patients are then cared for in the hospital’s Neurosurgical Intensive Care Unit and/or the 30- bed Advanced Brain and Spine Unit. All stages of care are staffed with nurses experienced in the diagnosis, treatment, and complications of stroke patients. Hemorrhagic strokes, including aneurysmal rupture, have a distinct care pathway, led by our neurosurgeons, neuro-interventional radiologists and neurologists together with our intensive care physicians. Preventative aneurysm treatment using image-guided micro-interventional techniques is a component of the Stroke Program’s portfolio.

Program highlights include a ranking in the top 5% in the nation for stroke care by Healthgrades. Hoag has been awarded the Stroke Gold PLUS Performance Achievement Award by the American Stroke Association for eight years in a row. Hoag has dramatically increased the rate at which IV tPA is administered to all acute ischemic stroke patients—up from 2% a decade ago to 15.5% currently. This rate triples the national average of 5%. Of the patients arriving in the Emergency Department meeting the criteria for the drug, 100% of patients received treatment. At 90 days, 66% of Hoag’s stroke patients return to a self-sufficient lifestyle.

Hoag’s Stroke Program is led by David Brown, M.D., a neurologist with a specialty in stroke and cerebro- vascular disease and a neurohospitalist. Dr Brown leads the dedicated, multi-disciplinary acute stroke response team that provides immediate care to stroke patients throughout the hospital, and meets regularly for process improvement.

The nurse navigator for the program is Deb Mastrolia, R.N. Deb is certified with the American Board of Neuroscience Nursing for both Neuroscience nursing CNRN and Stroke nursing – SCRN along with the American Association of Critical Care nursing – CCRN specialty. She has worked with Dr. Brown to help develop and certify a multidisciplinary stroke team. She also consults as a program reviewer for Stroke certifying agencies. Our Physical Rehabilitation team is also key to our superior outcomes.

Functional Outcomes

All stroke survivors are called at 30 days and 90 days post discharge by a neurosciences research nurse. A telephone interview is performed to assess functional status of the survivor. Valuable teaching is reinforced regarding neurology follow-up appointments, medication teaching, risk factor modification, stroke symptom identification and the need to call 911 for any recurring signs of stroke.

Treatment

Support & Education

A stroke support group meets monthly in the Hoag Conference Center, as does a brain aneurysm & AVM support group. There is an educational presentation at each, along with Q&A facilitated by the stroke nurse navigator. The meetings are attended by survivors and their families and friends.

Community outreach is provided through educational presentations by Dr. Brown and Deb Mastrolia at both Hoag Hospital Newport Beach and Hoag Hospital Irvine. They teach the signs and symptoms of a stroke, stroke prevention and treatments. The Stroke Program also attends employee health fairs, senior centers and events, and performs blood pressure checks, while reviewing stroke risks and prevention. Hoag Stroke Program partnered with Strike Out Stroke, a non-profit organization, to hold a stroke awareness event at Angels Stadium in July.

New to the program in 2015, Victoria Tomczak has come on board as the Neuroscience Data Coordinator. Victoria’s role has been instrumental in assisting with data compilation for the Stroke Program

Clinical Research

Acorda Protocol No DALF-PS-1016 A Double-Blind, PlaceboControlled, Parallel-Group Study to Evaluate the Efficacy and Safety of Two Dose Strengths of Dalfampridine Extended Release Capsules for Once Daily Administration for Treatment of Stable Walking Deficits in Post-Ischemic Stroke (MILESTONE) October 2014


Genentech Protocol ML29093: A PHASE IIIb, DOUBLE-BLIND, MULTICENTER STUDY TO EVALUATE THE EFFICACY AND SAFETY OF ALTEPLASE IN PATIENTS WITH MILD STROKE: RAPIDLY IMPROVING SYMPTOMS AND MINOR NEUROLOGIC DEFICITS (PRISMS) 2014


Astra Zeneca SOCRATES: A Randomized, Double-Blind, Multinational Study to Prevent Major Vascular Events with Ticagrelor Compared to Aspirin (ASA) in Patients with Acute Ischaemic Stroke or TIA (D5134C00001) 2013