From Good To Great

Well-organized cooperation in many medical areas ihas undoubtedly contributed to a significant improvement in the quality of stroke care, writes Dr Marcin Rogoziewicz, Head of Neurology at 107th Military Hospital and Polyclinic in Wałcz.



The 107th Military Hospital and Polyclinic in Wałcz is an important point on the healthcare map of Poland’s West Pomerania Province. Founded by the Ministry of National Defense, the hospital was originally constructed to provide healthcare for uniformed services. It was transformed to serve the general public starting in 1999, and currently has 295 beds spread across 11 departments and 2 sub-departments. Today it is the only hospital in Wałcz, providing health care for the general population of the south-eastern part of the West Pomerania Province. It is also an important medical base which serves the Drawski military training ground. 

The Neurological Department’s Stroke Unit has 28 beds and provides medical coverage for approximately 220,000 inhabitants of the Wałcz and neighbouring counties. The dynamic development of the department has begun since 2015. Thanks to the initiatives taken, drug programs in the treatment of multiple sclerosis, post-stroke spasticity, focal dystonia and hemifacial spasm were obtained. At the same time large-scale implementation of intravenous recanalization therapy for ischaemic strokes was also started.

Currently, the hospital admits around 350 stroke patients per year. Over the past years, we have systematically improved the essential indicators for the treatment of stroke, including the number of patients treated with recanalization therapy and the door-to-treatment (DTT) time. Using the experience of reference centres (e.g. Institute of Psychiatry and Neurology in Warsaw), we undertook numerous training activities for the hospital medical staff and for emergency medical teams. We underlined the essence of the rapid implementation of the appropriate treatment and started entering the obtained data into the SITS and RES-Q registries. Due to the various training and organizational activities undertook at the beginning of 2018, we were able to reach a recanalization procedure rate of 29% of ischemic stroke patients with a DTT time average of 50 minutes. We thought that in our reality it was everything that could be done in this area.

In the middle of 2018 we started to work together with an Angels Initiative Consultant dr Katarzyna Leśna, who brought valuable knowledge on experience and standards in other centres of this type in other countries. Thanks to this acquired knowledge we were able to take further action to improve the treatment of stroke patients. We put special emphasis on pre-notification, faster interaction of the stroke department with the emergency, laboratory and radiology departments, and we implemented point-of-care bedside INR testing. The turning point was the implementation of recanalization therapy directly in the computer tomography laboratory. Currently, a patient receives a bolus and the remaining medicine on the CT table, and only then he/she is transported to the stroke unit. At present, the number of ischemic stroke patients subjected to recanalization treatment oscillates around 45%, while the average DTT time does not exceed 20 minutes! Since then, we have obtained one Gold and three Diamond awards in the ESO-Angels Awards program. The true success, in our understanding, is not only a one-off award but keeping a high level of treatment all the time.

Such results, in the treatment of stroke patients, would not be possible without the massive effort of all those directly involved in the treatment process. Well-organized cooperation in many medical areas including medical rescue service, emergency, laboratory, radiology department, neurological department and the stroke unit has undoubtedly contributed to a significant improvement in the quality of stroke care. The Angels Initiative turned out to be invaluable help as it showed us the areas of activity that could be improved. As can be seen from our hospital’s results, it worked.