Every Second Matters St. Joseph’s Health Stroke Care Program Saves Time and Lives

In the event of a stroke, time is critical as any delay in treatment can result in irreversible brain tissue damage. Swift action is paramount to achieving successful outcomes for patients. With this knowledge, the stroke care team at St. Joseph’s Health has implemented crucial time and life-saving measures to ensure their patients are getting the best possible care, when every second counts. By providing 24/7 availability to critical services, utilizing innovative medical advancements, and offering outpatient neurological care in a convenient location, the Primary Stroke Center at St. Joseph’s Health offers top-tier stroke care in Central New York.

“As the leading cardiac care program in the region, our team has a profound understanding of the link between heart disease and the elevated risk of stroke,” said Dr. Fahed Saada, neurologist and stroke program director.

St. Joseph’s neurology team diagnoses and treats a variety of neurological disorders in both inpatient and outpatient settings including Alzheimer’s disease, Amyotrophic lateral sclerosis, concussion, migraine, epilepsy, multiple sclerosis, Parkinson’s disease, and stroke. They see patients with acute neurological symptoms at the main campus on Prospect Avenue in Syracuse as well as outpatient follow-up and new patient referral at the neurology clinic on W. Genesee Street in Camillus.

Commitment to Quality Since 2018, St. Joseph’s Health Hospital has been designated a Primary Stroke Center by the New York State Department of Health and DNV GL Healthcare, dedicated to upholding the highest standards of stroke care, leading to improved outcomes for their patients.

“Patients at St. Joseph’s Health often prefer to continue their care with us, especially those receiving cardiac treatment, due to the increased risk of stroke associated with heart conditions,” said Dr. Saada. “It’s important that we cater to the needs of these patients who wish to remain within our care network. Our foremost goal is to deliver the highest level of care to our patients.”

This commitment to excellence is an important driver for maintaining the Primary Stroke Center certification.

As a Primary Stroke Center, St. Joseph’s Health meets these criteria:
• Brain imaging scans 24/7;

• Neurologists available to conduct patient evaluations and use clotbusting medications such as TNK when appropriate;

• A rapid response stroke team and specially trained physicians and nurses to administer immediate care;

• A stroke care unit for inpatients with specially trained nursing staff;

• Post-stroke recovery services and support;

• Stroke education provided to patients and their families by a stroke program coordinator, helping them understand stroke, rehabilitation, and prevention, usually an advanced practice nurse or nurse practitioner;

• Physical, speech, and occupational therapy to help patients regain movement and function and to prepare them for rehabilitation;

• Nutrition services to help patients make positive lifestyle decisions;

• Social work services to help patients and families cope with their neurological deficits. “We are proud to have the Primary Stroke Center Certification because it affirms that our medical team expertly addresses the full spectrum of stroke care

– diagnosis, treatment, rehabilitation, and education – and establishes clear metrics to evaluate outcomes,” said Meredith Price, senior vice president, acute operations at St. Joseph’s Health Hospital. “When someone suffers from a stroke, it is critical to get them to a hospital with expert understanding of the nuances for stroke care. This certification underscores our proven track record and unwavering dedication to excellence, reassuring our community that we operate at the highest level.”

In 2023, St. Joseph’s Health Hospital was awarded the American Heart Association’s Get With The Guidelines® – Stroke Gold Plus quality achievement award. This honor is given to hospitals for their commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines, ultimately leading to more lives saved and reduced disability. The stroke team meets monthly to review the guidelines and ensure they are continuing to meet the requirements set forth by the American Heart Association.

“This award is important because it highlights our ability to deliver evidence based care of the highest caliber to our patients. This is a testament to the unwavering dedication, hard work, and commitment of our exceptional staff,” said Price.

Multidisciplinary Team Effort
“Stroke care is a team effort that requires careful coordination and constant communication,” said Dr. Saada. “Collaboration with other services is really the heart of our approach.”

The multidisciplinary stroke care team at St. Joseph’s Health includes neurologists Syed Shah, MD and Savita Kumari, MD, as well as radiologists, CT technicians, laboratory technicians, nurses, pharmacists, and rehabilitative service providers like physical therapists, occupational therapists, and speech and language pathologists. These team members work in unison to provide a comprehensive care plan tailored to each patient’s recovery.

“The most important factor in caring for our patients is to facilitate teamwork and communication between the emergency room physician, neurologist, and radiologist to diagnose the stroke in a timely fashion,” said Dr. Kumari. “Our goal is to reduce the risk of long term disability.”

Delivering Care in a Timely Manner
One of the most important ways St. Joseph’s Health streamlines stroke care is by quickly mobilizing the team. Upon a patient’s arrival at the hospital via the Emergency Department or while en route with Emergency Medical Services, a Code Stroke is initiated. This prompts immediate action from the Emergency Department and expedites imaging studies and a neurological consultation.

“Every second counts and we want to make sure our patients receive the best care from the outset,” said Dr. Saada. Patients receive a CT scan within minutes of arrival, determining if the patient has Looking at the past nine months of data, the average time for a patient to arrive at the CT scanner (or ‘Door to CT’) at St. Joseph’s Health Hospital is 18 minutes, exceeding New York State’s Department of Health goal of 25 minutes.

“There is a four-and-a-half-hour window of opportunity to treat the stroke, in order to reduce neurological deficits,” said Dr. Shah. “This timeframe gives the greatest chance of our patients returning to normal life post stroke.”

Ischemic stroke patients receive intravenous thrombolytic, or clotbusting medication, at the CT scanner as long as they’re still within that four and-a-half-hour window since the onset of symptoms. The medication breaks up and disperses a clot before it has an opportunity to prevent blood from reaching the brain. If there is any brain bleeding at all, the patient is not a candidate for thrombolytic.

Once the patient is admitted to the hospital, they undergo further imaging studies like MRI and echocardiogram help the team develop a care plan.

“These imaging studies allow us to quickly assess and respond to every stroke and obtain the most accurate diagnosis in the shortest period of time,” said Dr. Kumari.

Nurses, certified by the National Institutes of Health (NIH) in stroke care, monitor patients round the clock and are trained to identify neurological changes and deficits. 

Advanced and Innovative Treatments 

Since joining St. Joseph’s Health in 2016, Dr. Saada has implemented several advanced and innovative tools and technologies. One such change is the use of tenecteplase (TNK tPA) as the preferred thrombolytic over other alternatives like alteplase. Recent trials have shown higher efficacy with tenecteplase in treatment of acute ischemic stroke.

“The use of tenecteplase instead of alteplase has changed our patients’ outcomes significantly with fewer complications and better outcomes,” Dr. Saada said.

In the last two years, St. Joseph’s Health Hospital has added two weight measuring beds to their stroke care toolkit, allowing providers to obtain an accurate patient weight as soon as they come into the CT scanner. TNK tPA is a weight-dependent medication so having these beds immediately available for our stroke patients is essential to being able to administer it as quickly as possible.

“Investing in specialized equipment, such as weight measuring beds dedicated to stroke patients, reflects a commitment to providing tailored care that meets the specific needs of stroke survivors,” said Price. “These beds are crucial for patient safety aiding in their recovery process.”

Dr. Kumari’s subspecialty is electrodiagnostic studies. She performs electroencephalography (EEG) to diagnose seizure disorder and nerve conduction studies/electromyography (EMG) to diagnose and treat conditions like neuropathy and muscle disorders. 

“Some patients with stroke develop seizures and sometimes seizure can mimic stroke symptoms. We can perform testing like the EEG or longterm brain rhythm monitoring to accurately diagnose seizures and treat the patient appropriately,” said Dr. Kumari.

Before 2023, patients having seizures who required an EEG after hours or on weekends would have to wait for an EEG technician to be called into the hospital.  Today, St. Joseph’s Health Hospital has partnered with Ceribell, an EEG Point of Care company. Electrodes are attached to a headband which can easily be placed on a patient and providers can see results within two minutes.

“This is breakthrough technology, and we have it available 24/7,” said Dr. Saada. “Many patients are waiting as long as two to three months to receive these neurophysiology services at other facilities.”

Access to Care Around the Clock

St. Joseph’s neurologists are available 24/7 to assess inpatient and emergency department patients. Outside of normal working hours, a Tele Stroke program uses telemedicine through HIPA compliant software solution, Jabber. Neurologists virtually assess patients in as few as four to five minutes. The availability of this technology not only expands the reach of stroke care, but also ensures that neurologists can provide high quality care without being overwhelmed, sustaining the program’s effectiveness and efficiency.

St. Joseph’s Health Hospital also partners with Upstate University Hospital to assist with covering this service outside of normal working hours, as well as providing mechanical thrombectomy if the patient has a large enough clot preventing blood from getting to the brain (only necessary in about 10% of stroke patients).

“We collaborate with the Comprehensive Stroke Centers at Crouse and Upstate in case of an occlusion,” said Dr. Shah. “They are our partners and at the end, the ultimate goal is excellent patient care.”

Since October 2018, regional hospitals have been able to rapidly airlift emergent cardiac and stroke patients directly to St. Joseph’s Health Hospital’s helipad. The St. Joseph’s Health CareFlight program significantly reduces transit time, ensuring patients receive world-class care as quickly as possible, thereby greatly enhancing their chances of positive outcomes.

“Our expert team can treat patients from surrounding counties who are facing life threatening stroke and cardiac emergencies much faster than if they were transported by ambulance,” said Price. “Every minute a stroke remains untreated results in the loss of millions of brain cells. By slashing transit time, we ensure patients receive world-class care at the earliest possible moment, dramatically enhancing their chances of a favorable recovery.”

Investment in Stroke Education and Training
Scott Ward, Clinical Program Director of the Stroke Care Program, delivers stroke care training and education, especially for new nurses on the dedicated stroke unit. Course offerings include how to call a Code Stroke, identifying neurological deficits, administering tenecteplase, understanding ischemic vs. hemorrhagic strokes and their treatment, and using the NIH Stroke Scale to assess patients and relay this information to the  neurologists.

“Allocating time for nurses to  receive specialized education on stroke care is a priority,” said Ward. “This ensures that the nursing staff is well-versed in the latest stroke care protocols and techniques, enhancing patient outcomes.”

As a Primary Stroke Center, St. Joseph’s also works to educate members of the community on identifying the signs of stroke. 

“Stroke is preventable,” said Ward. “But people have to know what to look for.” Stroke can present with classic symptoms and an easy way to remember common stroke symptoms is using the acronym

B = Balance: sudden loss of balance.
E = Eyes: Sudden loss of vision.
F = Face: Facial asymmetry or numbness on one side of the face.
A= Arm: Weakness or numbness of one arm or leg.
S= Speech difficulty: Sudden change in the speech, slurred speech or word finding difficulty.
T= Time: Time is important for stroke care; call 911 immediately if any of the above neurological symptoms develop.

Other symptoms which may not be easily recognizable include headache, dizziness, blurring of vision, confusion, and a change in level of consciousness. “Even if there is the slightest suspicion of a stroke, you have to immediately seek medical attention,” said Dr. Shah. “I have seen cases where a patient’s speech is impaired, but they waited for two to three days to seek care. Or their arm is numb, and they think they slept wrong. As a society, we need to educate people, especially the older population, on what to look for and the importance of not delaying treatment.”

Outpatient Care in a Convenient Location
With the establishment of an outpatient neurology clinic in Camillus, Drs. Saada, Kumari, and Shah see patients very soon after they’ve been released from the hospital. They also provide 

treatment for a variety of other neurological conditions such as Alzheimer’s disease, amyotrophic lateral sclerosis, concussion, migraine, epilepsy, multiple sclerosis, Parkinson’s disease, and myasthenia gravis.

“The clinic benefits both our program and our patients,” said 

Dr. Shah. “We educate them on their condition and provide them with care in a comfortable, compassionate setting. Our patients are treated with kindness and care, and we are completely focused on their needs. When they leave their appointments, they understand their conditions and the treatment plan better. This goes a long way in ensuring their long term health.”

One of the most rewarding aspects for the neurologists is the ability to follow up with their patients post-stroke and see the results of their rapid response in the hospital.

“The best thing about our stroke program is when you see a patient after they have had a stroke and there is no disability because someone made the decision to give them clot busting medication,” said Dr. Shah. “I had a patient in his late 40s who had a significant stroke and his left side was compromised, but with PT and OT, he is back to 80%. Now he is thinking of going back to work. It is very fulfilling to see that.” “I am so proud that our team works incredibly well together and provides such excellent care to our patients,” said Dr. Kumari. “It’s very rewarding to know we are helping so many people live long, fulfilling lives.”

As the program grows, St. Joseph’s Health plans to add a physician’s assistant to the team.

“Our vision is a world where the devastating impact of stroke is minimized through excellence in care, compassionate education, and a relentless pursuit of better outcomes,” said Dr. Saada. “We are not just treating conditions, we are caring for individuals, supporting families, and educating communities to recognize and respond to strokes.”

Drs. Saada, Kumari and Shah are accepting referrals for patients with any neurological concerns. Call (315) 833- 9901.

For air transportation for emergency cardiac and stroke cases, regional hospitals may call the St. Joseph’s Health Hospital Transfer Center at 315-726-6120.