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How This Doctor Is Leading National Effort to Improve In-Hospital Stroke Recognition, Care

February 15, 2022

Dr. Amre Nouh, Hartford HealthCare Ayer Neuroscience Institute System Director of Stroke and Cerebrovascular Disease, is leading a national effort to better recognize and treat patients who suffer stroke while in the hospital. Nouh is lead author of a new scientific statement from the American Heart Association (AHA) that aims to create best practices about this high-risk group. In the United States, it’s estimated that there are anywhere from 35,000 to 75,000 in-hospital strokes each year. Dr. Nouh says he believes that number to be much higher and that incidents are likely underreported. “For community onset stroke where the patient comes in through the Emergency Department, those protocols, best practices and training have been hardwired for 30 or 40 years,” said Dr. Nouh. “For those patients in the hospital, the symptoms are often under-recognized or delayed because no one is thinking stroke—leading to delays in care and poorer outcomes.” Dr. Nouh says these patients are in the hospital for other illnesses when they develop stroke symptoms that can be missed as the care team is focused on the primary reason for hospitalization.  About two years ago,  the AHA appointed Dr. Nouh to lead this effort for in-hospital stroke.  The scientific statement has been published in Stroke and he presented this at the International Stroke Conference on Feb. 9. The scientific statement to improve recognition of in-hospital stroke lists five core quality improvement initiatives that hospitals should undertake to improve in-hospital stroke care.

  • Ensuring all hospital staff know how to activate in-hospital stroke alerts and are empowered to do so.
  • Creating a rapid response team with dedicated stroke training with those on team having neurological expertise or immediate access to neurological expertise.
  • Standardizing evaluation of those patients with physical assessment and imaging protocols.
  • Addressing any barriers to treatment and lack of resources or expertise that might necessitate transferring from one hospital to another with a high level of care.
Establishing a quality oversight committee to measure metrics related to In-hospital stroke and provide feedback for improvement. To read “Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: A Scientific Statement From the American Heart Association” click here.