World-class Stroke Project

Posted on 1 September 2021

Emergency Medicine Manager Dr Melanie Stander explains how Mediclinic’s innovative stroke initiative is making a difference.

Since 2017, Mediclinic has been involved in a formal project to streamline and standardise stroke treatment protocols, across all hospitals. “A stroke is a major medical emergency,” says Dr Stander. “In the past, a stroke patient wasn’t treated with the same urgency as today. We now know that certain options of treatments can be highly effective in stroke cases – but only if these patients are received, assessed and treated early. Thanks to an ongoing body of international evidence, we are now aware that stroke patients who are treated in a standardised and timeous manner, with a dedicated multi-professional stroke team, have much better outcomes.” In other words, the sooner a patient is assessed after the onset of a stroke, the earlier medical experts may be able to intervene and prevent further damage to the brain.

“International protocol suggests we have a four-and-a-half-hour window period after the onset of symptoms in which to determine a patient’s optimal course of treatment,” Dr Stander explains. “Depending on the type of stroke, either ischemic (clot) or haemorrhagic (bleeding), there are a few treatment modalities that your doctor will explain to you.”

For example, thrombolysis, or fibrinolytic therapy, involves using intravenous medication to break down blood clots that have formed within blood vessels. “This treatment is not indicated in all instances, which is why it is important to seek medical assistance as soon as possible so that the right treatment can be applied,” Dr Stander adds. “In some scenarios, we might not be able to do anything about the stroke that happened, but we can implement certain things to minimise the consequences of the stroke.”

Mediclinic Emergency Centres are now equipped with easily accessible stroke clinical pathways, including everything doctors and nurses require to document and direct the treatment process. “Stroke is a time-sensitive disease, and for this reason, the first and most important thing to determine is the time of onset of the symptoms,” says Dr Stander. “From there, we need imaging to determine what type of stroke it might be, i.e. ischemic or haemorrhagic. This is typically done by either a CT scan or an MRI scan. Once the scan is complete, the multidisciplinary team can make an informed decision on the best treatment pathway to follow.”

“Strokes present with a variety of symptoms, and it can be difficult to determine what type of stroke a patient has had using only a history and physical assessment,” Dr Stander adds. To determine the best course of treatment, Mediclinic health specialists perform the same list of clinical checks every time. “Doctors will follow a specific process to examine the brain and nervous system,” Dr Stander says. “This approach helps to determine which side of the body and brain has been affected by the stroke. They will also grade the severity of the symptoms. This is over and above taking the patient’s medical history and conducting an examination. Streamlining that process has made things quicker and easier for our doctors, and better in the long run for our patients.”

With the Stroke Project, Mediclinic has created an integrated model for stroke care across all Mediclinic facilities, which ensures that all stroke patients are treated timeously in the most appropriate facility to ensure the best possible outcomes.