Saving Lives with AR SAVES

Janie Evans, RN, BSN

“The Stroke Belt” has been tightly fastened around America’s southeastern states for several years. Arkansas, in particular, has felt the effects as it has one of the highest stroke death rates in the country, according to the Arkansas Department of Health. However, that belt is slowly releasing its grip as the stroke death rates and stroke hospitalization rates in Arkansas experience a decline.

For their contributions in the effort to improve those rates, Janie Evans, BSN RN CCRN, White River Medical Center (WRMC) Clinical Educator/Trauma Program Manager, and the hospital were recently recognized at the Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) Telestroke conference in Little Rock.

Evans was named the 2013 Nurse Facilitator of the year for AR SAVES. She also received an award from the Arkansas Department of Health for her Outstanding Collaborative Effort on the Emergency Medical Services (EMS) Pilot Program. WRMC was awarded Best Defect-Free Care in the Medium Stroke Volume Category.

Evans began the effort to have WRMC as the North Central Arkansas facility participating in the EMS Pilot Program after being approached about the idea by paramedic Greg Johnson who is the Performance Improvement and Compliance Coordinator for Vital Link EMS.  Vital Link is contracted with the Arkansas Stroke Registry (ASR) as the statewide EMS Stroke QI Specialist, with Greg serving as program manager. The EMS Pilot Program enhances communication between EMS and emergency department personnel to improve stroke care. Studies have shown that stroke patients have the best chance of recovery if they get the right diagnosis and treatment within three hours, with the first hour being critical. While still in its early stages, the EMS Pilot Program is a collaborative effort between WRMC and Vital Link EMS to communicate critically important information so that a stroke care team can be assembled before the patient arrives at the hospital.

Using protocols developed by paramedics and emergency department personnel, Vital Link paramedics radio in a “code stroke” to the WRMC Emergency Room (ER) when they recognize a patient is experiencing stroke symptoms. As soon as the code stroke is activated, ER staff initiates the AR SAVES protocol, saving valuable time. This includes notifying the Radiology and Laboratory departments and alerting the AR SAVES Network. 

AR SAVES is a state-wide program where rural hospitals use interactive 2-way video communication (telemedicine) to communicate 24-7 with specialists remotely.  Through the program, WRMC ER physicians and the AR Saves Neurologist can determine the type of stroke and the best course of treatment. The telemedicine program, which is led by the University of Arkansas for Medical Sciences (UAMS), was implemented at WRMC in 2009 and Stone County Medical Center in Mountain View in 2012.

“For patients experiencing stroke symptoms, time is of the essence,” said Evans. “The Emergency Department and Vital Link EMS have worked hard to make this pilot program successful. Having access to immediate care can limit, or eliminate, the damage caused by a stroke.”

As Clinical Educator, Evans works closely with the Arkansas SAVES program and often takes her stroke education to the streets. “I attend events and fairs to educate the public on stroke symptoms. Many people having a stroke don’t recognize the symptoms and often shrug it off as something less serious. More importantly, although common in older adults, strokes can happen with any age,” she said.

Evans is familiar with the importance of being aware that strokes can happen at any age. Her grandchild experienced a stroke at six-months old. “It was scary. You don’t think it’s true, but my family is proof that it can happen to anyone, at anytime, and at any age.”

Evans has been at WRMC for 29 years. Throughout her nursing career, she has worked in many departments with much of her career spent caring for the most critically ill patients. She exemplifies WRMC’s philosophy of life-long learning and commitment to training by recently joining Trauma Coordinator Stacy Wright in completing training to become Advanced Stroke Life Support Instructors.

At the conference, White River Medical Center was also awarded by the Arkansas Department of Health for Best Defect-Free Care in the Medium Stroke Volume Category of the Arkansas Stroke Registry. White River Medical Center has been participating in the ASR since 2011. The ASR is a systems-oriented program for patient emergency transport, diagnosis and treatment data collection from participating hospitals, and quality improvement activities for optimal stroke care. Defect-Free care means the ER staff followed all the right protocol when a patient showing signs of stroke came to the ER. WRMC was one of three hospitals in the state recognized by the Arkansas Department of Health. Since starting the program at WRMC, approximately 160 stroke patients have been linked to specialists through the telemedicine program. Nearly 25 have been given the life-saving tissue plasminogen activator (t-PA), a clot busting drug that’s effective for patients experiencing strokes resulting from brain clots.

“I am very proud of our ER staff and EMS providers.  Their efforts are improving stroke statistics, but more importantly we are saving lives and preventing permanent disability” she said.

Stroke symptoms include paralysis in the face, arms or legs; slurred speech; difficulty remembering; and blurred vision. If experiencing these symptoms, call 911 immediately.

WRMC is a 235-bed regional referral center and the flagship facility of White River Health System (WRHS). WRHS is a not-for-profit healthcare system serving residents throughout North Central Arkansas.  The system includes hospitals, outpatient facilities, primary care and specialty physician office practices.  White River Health System is a member of the Premier Alliance, the American Hospital Association, and the Arkansas Hospital Association and licensed by the Arkansas Department of Health.