National Stroke Week 2020 – how COVID-19 is impacting stroke care

This week is National Stroke Week and serves as a timely reminder to brush up on our knowledge about how to detect early signs of a stroke.

FAST is an easy way to remember and identify the most common signs of a stroke. The FAST Test involves asking the following questions:

  • Face – Check their face. Has their mouth drooped?
  • Arms – Can they lift both arms?
  • Speech – Is their speech slurred? Do they understand you?
  • Time – Is critical. If you see these signs call 000 straight away

By remembering these points, you can be proactive in helping save lives and be a FAST Hero.

At Monash Health, we are proud to have a large team who are dedicated to providing excellent stroke care. Led by Professor Henry Ma, Director of Neurology and Head of the Stroke Unit at Monash Health, the team takes a multidisciplinary approach to stroke care. The service spans across a number of treatment and support areas including:

  • Emergency medicine
  • Neurology
  • Diagnostic imaging
  • NeuroInterventional radiology
  • Neurosurgery
  • Neurophysiology
  • Anaesthetics
  • Intensive care
  • Acute inpatient care
  • Allied health
  • Pharmacy
  • Clinical research
  • Subacute services.

This multidisciplinary approach allows the team to provide the highest quality care to stroke patients. Monash Health is one of two dedicated state-wide centres for endovascular clot retrieval and, as a result, sees an increasing number of emergency presentation and stroke admissions.

During the COVID-19 pandemic, the team has adjusted the way they deliver this care to patients. Dr Jason Vuong is a stroke registrar and has seen firsthand the impact of COVID-19 on patients and employees. Dr Vuong attends all stroke codes at Monash Medical Centre, with the majority occurring in the emergency department. He is also responsible for coordinating acute stroke presentations at Dandenong Hospital and Casey Hospital.
“A typical day involves assessing stroke codes when they are called and coordinating hyperacute stroke treatment if indicated (thrombolysis, endovascular clot retrieval). When there are no stroke codes running, I fill my time with a combination of stroke outpatient clinics, stroke clinical trial patients and stroke research.”

Dr Vuong has experienced the way COVID-19 has impacted patient care in the clinical setting. He and the team have adjusted the way they deliver stroke treatment and care to ensure the safety and wellbeing of both staff and patients.

“A substantial proportion of our stroke code patients with large strokes cannot answer screening questions regarding COVID-19 and thus are triaged and managed with suspected COVID (sCOVID) precautions in the Emergency Department,” Dr Vuong said.

“We are still prescribing alteplase as thrombolysis and the Emergency Department has been extremely helpful in adapting to give hyperacute treatment in sCOVID precautions. Our endovascular clot retrievals are being performed largely under general anaesthetic to protect the wellbeing of staff members in emergency procedures.

“The personnel attending stroke codes has also changed to comply with restrictions in our emergency department as well as the wards. This also minimises employees seeing patients in high-risk areas.”

During the COVID-19 pandemic, there have been reports that patients are more hesitant to receive treatment at a hospital. Dr Vuong has noticed this in the clinical setting:

“Patients are unfortunately presenting later than what they traditionally have. This is usually because patients are hesitant to come to hospital and try waiting it out at home until they eventually call an ambulance. This precludes a large proportion of patients with strokes for hyperacute treatment as they fall outside the time window for thrombolysis, and in clot retrieval candidates there is a risk of increased established infarct.”

Although COVID-19 has presented many challenges to teams across the organisation, it has also increased cross-department collaboration with Dr Vuong noting the “greater teamwork between the Emergency Department, Radiology, NeuroInterventional Radiology and the stroke team.”

The stroke team continues to adjust their practices to ensure that patients are continuing to receive exceptional care during this time. Well done to Professor Henry Ma, Dr Jason Vuong and the entire Stroke Unit.

Approved by Anjali Dhulia. 4 September 

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