Stroke providers need to balance the overall needs of the community while remaining advocates for those with stroke and the safety of providers, including making adjustments in the delivery care that should be adapted to each unique environment.
Additionally, as care continues during the pandemic, stroke providers need to rely on prediction modeling and surge planning to continue to adapt to best serve all patients with stroke.
These recommendations are noted in a study published recently in Neurology.
Providing recommendations for the treatment of these patients is even more complex and based on the information that the community has to work with—which often lacks evidenced-based analysis and in-depth consistency in their investigation—the ability to create a standard approach or treatment for these patients is complicated even further, notes Andrew N. Russman, DO, head, Stroke Program, and medical director, Comprehensive Stroke Center, Cleveland Clinic, the study’s lead author, in NeurologyTimes.
“That’s what we should take away from this—we need more data and more information, a registry of these patients, and then, potentially, randomized studies of how we’re going to approach treatment in this population,” he says.
For the delivery of stroke care, Russman et al note that the community should prepare for the possibility of physician shortages and that restructuring stroke call and inpatient services might be required to maintain a viable workforce of providers. Additionally, they advised that contingency plans include that neurologists with stroke expertise be prepared to assume consultative roles in different facilities as well as make treatment triage decisions in a multidisciplinary sense, similar that utilized in critical care.
They recommend that in acute stroke, all of those patients in highly contaminated areas should be approached as potentially infected.
“Acute stroke is an area with high-risk for provider exposure to infection; it is a fast-paced setting, involving multiple patient interactions and limited opportunities for COVID-19 screening with patients who often have impaired cognition and language,” they write.
Video conferencing is also recommended as a supplement to trainee education while maintaining physical distancing, which they noted has seen “across the country at all levels of educational programming.”
Protocols to protect personnel who are caring for those with acute stroke should depend on the availability and reliability of COVID-19 screening and testing, and in light of a crisis capacity mode, the role of trainees might need to be redefined, according to the recommendations.
As for research, the group acknowledge that the pandemic has created a challenge in conducting trials and studies with the risk of exposure, and write that “as a research community, a reasonable conclusion is that research that does not involve in-person contact is logistically feasible.”