By Pete Woody

Caring for the whole patient, not just a set of symptoms or problems, is a core value of VCU Health that is reflected daily across our health system.

For team members in the Ambulatory Care Center (ACC) 2 Primary Care Clinic, this unwavering commitment to patient care has included a particular focus on educating team members and patients on the signs and symptoms of stroke. Their dedication recently earned them a platinum-level designation, the highest level available, as a “Stroke Smart Medical Practice” from the Virginia Department of Health (VDH).

The VDH Stroke Smart Medical Practice program launched in 2023, and the ACC 2 Primary Care Clinic was the second practice in the state to receive the designation. The program aims to tackle two challenges in stroke care:

• Reducing the incidences of delayed care for patients that call a primary care practice for an appointment; primary care is to instruct patients with signs of a stroke to call 911
• Increasing public awareness on stroke signs

According to VDH, studies suggest that 33% of people having a stroke will call their doctor's office for an appointment, likely because they do not understand the urgent need to call 911. The findings seem to ring true for the ACC 2 Primary Care Clinic as they have had a number of patients call or come into the clinic with stroke symptoms instead of calling 911. This can delay the time it takes to receive care, which for a stroke patient can mean the difference between life or death.

“The Stroke Smart Medical Practice designation lets people know that this unit has a heightened awareness of the devastating results of having a stroke,” said Gilbert Stalnaker, M.S.N., B.S.-R.N., C.E.N., C.N.-V., assistant clinical manager of the ACC 2 Primary Care Clinic. “We are trying to help with prevention, and in recognizing that when stroke symptoms happen, the only call is 911.”

Platinum-level designation indicates that the ACC 2 Primary Care Clinic has implemented and consistently practices four or more of the Stroke Smart Medical Practice criteria, which includes the following:

• Train office staff to spot strokes and follow the practice protocol if a stroke is suspected
• Ensure Stroke Smart education and materials are available for all patients (i.e., wallet cards, magnets, posters or videos)
• Identify high-risk patients and provide intentional education and materials
• Incorporate Stroke Smart script in phone system recordings
• Track metrics on Stroke Smart activities

This awareness is an extension of VCU Health being a leader in stroke care, education and research and the first certified Comprehensive Stroke Center in Virginia. Stalnaker has been involved in stroke care at VCU Health in a variety of ways during his career. He credits strong collaborations with stroke program manager Stacie Stevens, Ph.D., F.N.P., R.N., and emergency department physician Ramana Feeser, M.D., as the main reason the ACC 2 Primary Care Practice has successfully applied the principles of the Stroke Smart Richmond campaign.

“The Stroke Smart Medical Practice designation represents VCU Health as a leader in stroke management and in recognizing what stroke care looks like,” Stevens said. “We are a leader in terms of our commitment to patients and a willingness to go beyond our hospital walls to make a difference in our communities.”

The practice officially received the designation at the Virginia Stroke Systems Task Force meeting in July. But the initial steps were taken in the summer of 2022, before the designation was even created, and were driven by nurses within the clinic.

Led by Lauren Young, B.S.N., R.N. C.N.-III., team members began looking into protocols for recognition and management of stroke in the ambulatory setting. The goal was to train anyone who may encounter a patient, including both clinical and non-clinical team members, on the signs and symptoms of stroke.

“It’s important for all team members to know stroke symptoms. Everyone needs to have knowledge to get help quickly for a patient. That can save time, which is what it’s all about with stroke care,” Young said.

With that foundation in place, the next step for team members was increasing awareness of stroke signs with patients and their families. This aspect was led by Katie Northway, B.S.N., R.N., C.C.R.N., C.N.-IV, who said her experience in emergency department and ICU settings, along with primary care, has given her a deeper understanding of patient behaviors.

“Working in primary care has helped me recognize how many people would prefer to see their primary care doctor instead of going to the emergency department,” Northway said. “But calling primary care takes time, and with a stroke, time is brain.”

Because of the information the practice team members have provided to patients about calling 911, Northway said they’ve noticed a decrease in the number of calls the practice has received from patients experiencing stroke symptoms, such as loss of balance, vision changes, facial numbness or drooping, arm weakness, or speech difficulty.

Young and Northway saw an immediate need to improve staff awareness and recognition both in the clinic and during triage, which ultimately progressed into a process for educating their patients to spot a stroke and take the steps to save lives.

According to Feeser, the collaboration that was involved, not only within the practice but also with the stroke program and emergency department, also ensures a standardized, comprehensive and evidence-based approach to stroke care that benefits VCU Health patients and team members.

“We are leveraging team members from diverse backgrounds to combine their skills and knowledge in the best way possible,” said Feeser of the work that has gone into earning Stroke Smart Medical Practice designation. “By doing this, we achieve the best possible outcomes for our patients.”