Hospitals pursuing state stroke center designations

Westchester County Business Journal, Sep 12, 2005 by Philippidis, Alex

Less than a year after the state Health Department established a new designation for programs that treat cases of acute stroke, Westchester hospitals are lining up to receive it and highlight their advances in treating the deadly disease.

White Plains Hospital Center became Westchester's first hospital to win the state's "Regional Stroke Center" designation earlier this summer, making it only one of about 25 such hospitals in the state.

Six other Westchester hospitals say they are seeking the designation, four of which predicted they would hear similar good news by the end of the year. Hudson Valley Foy Hospital Center in Cortlandt needs only a state inspection for stroke center status, while Lawrence Hospital Center in Bronxville, Northern Westchester Hospital in Mount Kisco, Saint Joseph's Hospital in Yonkers and Sound Shore Medical Center in New Rochelle are awaiting word from Albany.

"We're expecting a decision any time now," said Sal Schiliro, a Sound Shore spokesman.

Westchester Medical Center has put in its application, spokesman Danny Loughran said, while Yonkers-based Riverside Health Care System expects to put its application in this month.

"We thought it was important since we're the busiest emergency room in Westchester County that we have the service because we see a lot of stroke patients. We need to offer the best, state-of-the-art care for stroke," said Jon B. Schandler, president and chief executive officer of White Plains Hospital Center.

More than 75,000 patients are projected this year to visit that emergency room, which will double in size over the next 18 months, with construction set to start this fall.

White Plains now treats about 300 stroke patients annually, a figure Schandler expects will rise until Westchester's other hospitals receive the stroke designation over the next several months.

Stroke kills 170,000 Americans each year, making it the thirdleading cause of death in the United States.

Some 700,000 Americans experience the disease, which involves an interruption in blood flow to the brain due to a clot or leakage of a blood vessel.

"You could characterize it as a brain attack," Schandler said.

Hospitals with "stroke center" status commit to treating stroke patients within three hours, the time window for effectiveness of the clot-busting drug tPA (tissue plasminogen activation), used to unclog blood vessels in patients who have not had surgery. Emergency medical services staffers treating stroke patients are likelier to bring them to hospitals carrying the state designation.

"Just getting in place systems to make sure that everything is done as quickly and is reasonably possible winds up with a much better outcome," said Jim Foy, Riverside's president and chief executive officer. Riverside consists of St. John's Riverside Hospital in Yonkers and Community Hospital at Dobbs Ferry.

He said the advent of the tPA drug has helped revolutionize stroke treatment, and spurred the state and others to rethink treatment protocols.

Till now, too often patients did not visit a hospital until a day or longer after experiencing the symptoms of stroke (See sidebar). The American Stroke Association says just less than 5 percent of stroke sufferers reach a hospital within three hours.

"More than half the time, patients who are experiencing stroke take over 24 hours to even come to a hospital. So the chances of them getting here and treated is very, very small," said Dr. Marla Koroly, Northern Westchester's chief medical officer.

As a result, all the hospitals pursuing the state designation have stepped up their stroke prevention efforts by visiting seniorcitizen centers and other community venues.

"It's something we really want to see in every hospital. It's not going to be just competing projects, but something that every hospital should want to pursue. It's good for the community," said John Federspiel, Hudson Valley's president and chief executive officer.

Hudson Valley does not expect its number of stroke cases to increase much beyond the current 200 per year, Federspiel said. In an Aug, 23 announcement, Saint Joseph's cited a 14 percent rise in stroke patients treated between 2003 (93 patients) and last year (106 patients).

Federspiel and administrators from all hospitals seeking stroke center status said the designation involved minimal equipment and personnel costs: "It really wasn't that difficult for us to meet the new standards."

Requirements include having writtencare protocols, round-theclock access to a stroke team, a neurologist available to read CAT scan results, a respiratory therapist and an ER staff trained in stroke treatment and capable of mobilizing rapidly to treat patients.

Schandler said his center investment reached "probably some hundreds of thousands of dollars."

Koroly said Northern Westchester has already implemented the treatment protocol required under the new state standard. Northern Westchester Hospital awaits approval from a committee of the state Health Department, then an inspection before it can receive the designation, she said.