'Seconds matter': Intermountain Health is lowering stroke response times at emergency rooms

A brain scan shows what a stroke looks like. Intermountain Health is working to increase the speed its smaller emergency rooms respond to strokes, because every minute counts.

A brain scan shows what a stroke looks like. Intermountain Health is working to increase the speed its smaller emergency rooms respond to strokes, because every minute counts. (Intermountain Health)


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MURRAY — K.C. Seeley was putting on his shoes to prepare to go to the gym in February when his wife Danni noticed something was wrong.

The Cottonwood Heights man said he was lightheaded and tired, but Danni Seeley said he wasn't able to tie his shoes. He told her he must have slept wrong, but she could tell it was more.

K.C. Seeley didn't want to get care, but his wife turned them around after getting to the gym and went to the hospital. She said the possibility of a stroke hadn't entered her mind because she thought it would come with a droopy face.

By the time they were at the hospital, K.C.'s left peripheral vision was gone, and he was having a hard time.

"I remember gripping the steering wheel, 'Just please don't make us wait,'" Danni Seeley recalled thinking.

Minutes matter

The woman at the front desk was checking someone else in but started interacting with the Seeleys. As soon as K.C. Seeley walked in, they brought the man in his 60s back to receive care quickly and diagnosed his stroke. She said staff members were "excited" to hear his symptoms began less than an hour earlier.

Shortly after receiving tissue plasminogen activator medication, also known as tPA, K.C. Seeley said he was able to move his arm again, and his vision got clearer — although it took months for his vision to return to where it is now with just a spot of blurriness.

Dr. Kathleen McKee, a neurologist at Intermountain Medical Center, said, "It really is a situation where seconds matter, and so having an algorithm where you can get the medicine in as quickly but safely as possible is really important."

She said the effective stroke treatment at large-scale hospitals is well known — there is a lot of research — but not everything done at the large hospital in Murray works for Intermountain Health's more rural emergency rooms.

Bringing that stroke response to rural hospitals

McKee and Kristy Veale, a nurse who worked with the neuroscience program, helped Intermountain expand its stroke response to each emergency room through a study that began in 2018.

Veale said she worked with each emergency room to help its staff improve response times, whether that meant giving patients CT scans before they changed into a hospital robe and were assigned a room, or having a stretcher available.

She worked with staff members on symptom identification so stroke patients aren't waiting in the lobby. McKee said they taught staff members to contact a neurologist through telehealth quickly, changing the culture of waiting until they were sure it was needed.

Through this effort, the time it would take to get a patient from the door of the emergency room to administering stroke medication was reduced at almost all of Intermountain's emergency rooms.

McKee said now about 90% of eligible patients receive tPA, the clot-bursting medication, within an hour of being admitted to the hospital, leading to more brain cells saved and less risk of permanent disability.

"We want to provide that same high-quality care to people who walk into any of our emergency rooms," McKee said.

She said previously it would often be a few hours because doctors were being careful — tPA given to the wrong patient can be very harmful.

"We are chasing perfection here. We were shaving five, 10, 15, 20 minutes off these times, but that's a lot of neurons. And so those 20 minutes matter quite a bit," she said.

McKee said some small emergency rooms may only have one patient a year who qualifies for the medication, but to that one patient, it makes a big difference.

Veale said staff members and nurses at each emergency room want to help their patients and were interested in ways they could save even just one minute.

"We gave ownership back to the hospital ... so they really felt empowered," she said.

She said every minute shaved off of a hospital's times was celebrated and would lead emergency rooms to look for another step.

Emergency room staff members also trained to work with neurologists to identify patients who should have surgery to remove the clot and reduce times for that patient to be on a plane, helicopter or ambulance to a larger hospital.

McKee said their study didn't just improve stroke care but developed a method to help smaller emergency rooms provide the same quality of care as larger hospitals for other conditions.

"The key is not to sort of dictate how it should be done, but to inspire each local culture and team to come up with their way that works for them," she said.

A public information chart teaches about stroke symptoms.  Intermountain Health is working to increase the speed its smaller emergency rooms respond to strokes, because every minute counts.
A public information chart teaches about stroke symptoms. Intermountain Health is working to increase the speed its smaller emergency rooms respond to strokes, because every minute counts. (Photo: Intermountain Health)

Stroke symptoms

Another piece of responding quickly to a stroke is for someone to recognize the signs and get the patient to an emergency room. The signs of a stroke include balance problems, vision loss, face drooping, arm weakness or speech problems.

The different signs correlate with the location of the clot in the patient's brain, so any one of these symptoms on its own is worth going to the hospital to have it checked out, McKee said.

McKee said a public education campaign is the next step to speed up the treatment process. Unlike a heart attack, strokes don't cause pain, so people often push off getting care when they shouldn't wait.

"We don't start to treat them until they get to the door. We need them to get themselves to the door," she said.

Danni Seeley encouraged people who have symptoms to not ignore it and to not go to sleep.

"If something's not right, something's not right," she said.

She expressed gratitude for those who worked at the hospital and saved her husband's life.

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Emily Ashcraft joined KSL.com as a reporter in 2021. She covers courts and legal affairs, as well as health, faith and religion news.

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