The UC Davis Medical Center Stroke Program features acute inpatient care as well as outpatient management of cerebrovascular disease. Patients are triaged in the Department of Emergency Medicine and receive aggressive medical care and treatment that includes:
- Thrombolytic therapy
- Interventional neuroradiologic techniques
- New medications under clinical investigation
Acute stroke team
Kwan Ng, MD, PhD, directs the program and team for acute stroke patients along with our Stroke Program Coodinator, Kellie Brendle, RN, MS, CNS. The team’s full complement consists of emergency medicine nurses and physicians, as well as in-house neurology residents and neurology faculty, including a stroke neurologist.
The goal of the Acute Stroke Team is to rapidly evaluate and treat acute stroke patients, including a door-to-needle time of one hour for patients who are candidates for intravenous tissue plasminogen activator (IV TPA). There is a written care protocol that features a list of inclusion and exclusion criteria for administering TPA as well as pre- and post-TPA treatment guidelines.
Acute stroke treatment:
- Intravenous TPA within a three-hour window is routine.
- Intravenous TPA outside a three-hour window on a case-by-case basis.
- Intra-arterial TPA within a six-hour window for patients with major strokes.
- Intra-arterial mechanical clot retrieval within an eight hour window for patients with major strokes.
Emergency Medical Services (EMS) coordinates efforts with the Department of Emergency Medicine for rapid transport of acute stroke patients. There are also ongoing educational activities for EMS and emergency department personnel.
Stroke services inpatient care
Stroke services inpatient care features a stroke unit with at least four beds and cardiac monitoring. Stroke services adhere to predefined admission orders for consistent, complete and efficient evaluation and treatment. Experienced neuroscience nurses staff the unit, which strives to house no more than three patients per nurse. The medical management is under the care of the stroke neurologist. Early rehabilitation is encouraged and guided by physicians from the Department of Physical Medicine and Rehabilitation. The unit also coordinates activities between nurses and therapists, including ongoing education.
Aggressive evaluation of stroke etiology occurs through multimodal testing with MRI, CT angiogram, catheter angiography, echocardiography, transcranial Doppler, hypercoagulable testing.
Specialized interventional treatment is available when necessary such as carotid endarterectomy, carotid stenting, intracranial artery stenting.
Intensive care unit treatment:
Where required by medical or neurological instability, patients are housed in a specialized neuroscience ICU and managed by multidisciplinary team to optimize medical and neurological treatment.
Patients developing life-threatening cerebral edema are treated by multidisciplinary team of neurologists, critical care physicians, and neurosurgeons. When appropriate, hemicraniectomy for large, space occupying strokes is available through our Department of Neurosurgery.
Inpatient ward care:
Stroke patients are assigned to specialized wards staffed by multidisciplinary teams of nurses, therapists, and physicians experienced and train specifically to care for stroke patients. Active education of patients and their families is a key component of their care. Specific measures relating to good clinical care of stroke patients is collected in a database and periodically reviewed to allow continuous improvement in quality of care. Patients receive early attention by speech therapy, occupational therapy, and physical therapy to initiate rehabilitation activities.
All stroke patients are evaluated for further subacute treatment in our specialized subacute rehabilitation wards. These wards are located directly adjacent to the acute hospital stroke wards to facilitate early evaluation and treatment by the Department of Physical Medicine and Rehabilitation.
Many imaging services are available to complement stroke services. In-house computed tomography (CT) is available 24 hours per day for patients needing special care. In addition, advanced neuroimaging is routinely available for magnetic resonance imaging (MRI), resonance imaging angiography (MRA) and interventional neuroradiology.
The stroke service also participates in the evaluation of new forms of treatment. Examples of treatment evaluation include intra-arterial thrombolysis, mechanical clot retrieval, new methods of patient selection to extend medication time window (neuroprotectants) and surgical and medical interventions.