Loyola Medicine Neurologist Calls for Broad Changes in Stroke Care During COVID-19

New guidelines may be needed to preserve health care resources, limit disease spread and ensure optimal care
7-May-2020 2:20 PM EDT, by Loyola Medicine contact patient services

Newswise — MAYWOOD, IL–Broad modifications to current standards for treating acute stroke patients during the COVID-19 pandemic may be needed to preserve health care resources, limit disease spread and ensure optimal care, according to a Loyola Medicine neurologist.

“Doctors are seeing a rise in COVID-19 patients of all ages suffering from stroke and other vascular complications, as the COVID-19 virus overwhelms the health care system,” said Jose Biller, MD, chairperson of neurology at Loyola University Medical Center, and professor, Loyola University Chicago Stritch School of Medicine, and co-author of a new editorial, “Acute Stroke Care in the Coronavirus 2019 Pandemic.”

“COVID-19 may increase the risk of stroke as a result of several mechanisms, including enhanced inflammatory response, increased blood clotting tendencies, and damage of the inner layers of the blood vessels (endothelial damage),” said Dr. Biller. In general, the majority of stroke patients are older and have underlying medical conditions associated not only with risk for acute ischemic stroke (AIS), but also poor outcomes associated with COVID-19.

Dr. Biller says new guidelines are needed to safely manage stroke patients, both with and without COVID-19, within the limitations of strained health systems during this “ferocious novel pandemic.” 

“We believe that it is crucial for the stroke community to relax guidelines and stroke pathways while continuously providing high quality of care, including treatment algorithms, post intravenous thrombolysis monitoring, diagnostic work up, disposition planning, prevention measures, in order to optimally care for stroke patients while minimizing the chances of contributing to the rapid spread of COVID-19,” according to the editorial, co-authored by Rima M. Dafer, MD, MPH, and Nicholas D. Osteraas, MD, MS, both of Rush University Medical Center, and appearing in the Journal of Stroke and Cerebrovascular Diseases.

The recommendations pertain to all aspects and stages of care, and include the following highlights:

  • Patients or loved ones should continue to call 911 to report a stroke. In addition to standard triage, emergency medical system (EMS) personnel should screen patients over the phone for COVID-19 symptoms. Telemedicine should be considered for patients with low suspicion of stroke, or mild symptoms with no potential indication for intervention. All patients with acute stroke symptoms should be treated as suspected or possible COVID-19 patients.
  • Emergency Room Evaluation. In the emergency room, patients should be screened for COVID-19 prior to evaluation by the stroke team. All patients should wear a mask.
  • Hospitalization. Hospitals should designate isolated units for stroke care. Patients receiving intravenous chemical thrombolysis (a common stroke treatment involving an intravenous injection of drugs directly to the blood clot) may be monitored virtually with two-way video conferencing to minimize staff infection.
  • Rehabilitation Planning. Rehabilitation for stroke patients can include physical, occupational, and speech therapy, along with other rehabilitation. All therapists and health care workers caring for COVID-19 patients should wear appropriate protective gear. Whenever appropriate, therapy services should emphasize patient exercises that can be used at home.
  • Family Members. As many hospitals have restricted visitors during COVID-19, extra effort will need to be made to reach families by phone to discuss a patient’s condition, treatment options and discharge planning. Exceptions to the visitor policy, such as discussions regarding end-of-life care, should be made when appropriate.
  • Stroke care often involves networks of hospitals; commonly a comprehensive “hub” with multiple smaller hospitals or “spoke” sites which transfer stroke patients to the “hub” for emergency treatment or Intensive Care Unit (ICU) care. Tele-stroke should be encouraged to evaluate patients and to prevent unnecessary transfers. For AIS patients, neuroimaging and COVID-19 screening should be obtained at the smaller, spoke site hospital before a patient is transferred to a larger medical center.
  • Discharge Planning. Discharges to acute rehabilitation institutions and long-term facilities have been delayed due to concerns about the spread of COVID-19 infections in long-term care facilities and nursing homes. Hospitals may need to designate rehabilitation beds for patients who do not qualify for transfer to acute inpatient facilities, as well as discussing possible discharge to home when medically stable and appropriate until the pandemic is under control.

Finally, the article recommends establishing stroke networks within cities, as well as collaboration between institutions “as the surge of COVID-19 worsens.” This should include “collaborations among stroke networks to establish a rotating weekly coverage for acute stroke care in a specified geographic area; thus, both freeing hospital resources and releasing stroke call responsibilities, and allowing these physicians to help in caring for patients on the COVID-19 units.”

 

For an appointment, or to schedule a surgery, procedure or in-person visit, call 888-584-7888, or visit www.loyolamedicine.org.

###

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in Chicago's western suburbs that includes Loyola University Medical Center (LUMC)Gottlieb Memorial HospitalMacNeal Hospital and convenient locations offering primary and specialty care services from more than 1,800 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. & Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for more than 50 years, Loyola also trains the next generation of caregivers through its academic affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 180 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research facility at the Marjorie G. Weinberg Cancer Center. MacNeal Hospital is a 374-licensed-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, including acute rehabilitation, an inpatient skilled nursing facility and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919. For more information, visit loyolamedicine.org.

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 106 continuing care locations that include PACE programs, senior living facilities, and home care and hospice services. Its continuing care programs provide nearly 2 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $19.3 billion and assets of $27 billion, the organization returns $1.2 billion to its communities annually in the form of charity care and other community benefit programs. Trinity Health employs about 129,000 colleagues, including about 7,500 employed physicians and clinicians.

SEE ORIGINAL STUDY




Filters close

Showing results

110 of 2776
Newswise:Video Embedded protocol-needed-to-monitor-covid-19-disease-course
VIDEO
Released: 3-Aug-2020 9:05 PM EDT
Protocol needed to monitor COVID-19 disease course
University of Washington School of Medicine and UW Medicine

Patients with underlying conditions such as asthma or other lung problems should be checked on regularly by pulmonologists or primary-care doctors for at least six months. Some will need to be monitored for one to three years, according to a new opinion piece posted online today in The Lancet-Respiratory Medicine.

Newswise: UM Cardiology Researchers Studying How COVID-19 Affects the Heart
Released: 3-Aug-2020 3:10 PM EDT
UM Cardiology Researchers Studying How COVID-19 Affects the Heart
University of Miami Health System, Miller School of Medicine

COVID-19 is shown to impact the heart and, in some cases, have long-lasting cardiac effects. To discover the extent to which COVID-19 affects the heart, cardiologists and researchers with the University of Miami Miller School of Medicine have begun multiple studies.

Newswise: Tackling the Bioethics Challenges Raised by COVID-19
Released: 3-Aug-2020 3:05 PM EDT
Tackling the Bioethics Challenges Raised by COVID-19
University of Pennsylvania School of Nursing

The diverse situations experienced by health-care workers during the COVID-19 pandemic often present serious ethical challenges. From the allocation of resources and triage protocols to health-care worker and patient rights and the management of clinical trials, new ethical questions have come to the forefront of today’s global public health emergency.

Newswise: 239156_web.jpg
Released: 3-Aug-2020 2:50 PM EDT
New species of fungus sticking out of beetles named after the COVID-19 quarantine
Pensoft Publishers

A major comprehensive study on Herpomycetales and Laboulbeniales, two orders of unique ectoparasitic fungi associated with insects and other arthropods (class Laboulbeniomycetes) in Belgium and the Netherlands was published in the open-access, peer-reviewed scholarly journal MycoKeys.

Released: 3-Aug-2020 1:30 PM EDT
Consumer Behavior Has Shifted Significantly During Pandemic, Survey Reveals
Rensselaer Polytechnic Institute (RPI)

The COVID-19 pandemic has brought about an increase in telework and online commerce, and a significant decrease in the number of personal trips people are making. Understanding the effects of these rapid changes on the economy, supply chains, and the environment will be essential, as some of these behaviors will continue even after the pandemic has ended. Researchers from Rensselaer Polytechnic Institute recently presented the results of two sets of surveys they conducted in an effort to quantify and understand these unprecedented shifts.

access_time Embargo lifts in 2 days
Embargo will expire: 5-Aug-2020 12:05 AM EDT Released to reporters: 3-Aug-2020 12:25 PM EDT

A reporter's PressPass is required to access this story until the embargo expires on 5-Aug-2020 12:05 AM EDT The Newswise PressPass gives verified journalists access to embargoed stories. Please log in to complete a presspass application. If you have not yet registered, please Register. When you fill out the registration form, please identify yourself as a reporter in order to advance to the presspass application form.

31-Jul-2020 4:05 PM EDT
The effects of COVID-19 on emergency visits, hospitalizations
Mayo Clinic

COVID-19 swept into the U.S., hospitals across the country have reported that their emergency departments are emptying out. In a new study published Monday, Aug. 3, in JAMA Internal Medicine, a team of researchers from multiple institutions provides insights into this phenomenon.

Newswise: Important Dementia Studies Continuing at UK Despite Ongoing COVID-19 Pandemic
Released: 3-Aug-2020 10:20 AM EDT
Important Dementia Studies Continuing at UK Despite Ongoing COVID-19 Pandemic
University of Kentucky

The COVID-19 pandemic brought many things to a screeching halt and continues to impact our daily lives. However, important research at the University of Kentucky’s Sanders-Brown Center on Aging (SBCoA) is continuing under extreme caution and deep dedication. A monumental study in the field of dementia research is set to get underway in the coming weeks at UK.


Showing results

110 of 2776

close
2.22748