– as told by Dr. Justin Coomes
+ “I’ll never forget that day.”
I was in a difficult central line at the time, easily one of the most difficult of my career. I could not leave my patient’s bedside. Tracee Tewell, a PA who has worked in our emergency department for six years, responded to the stroke alert called for a male patient, performed the initial evaluation and spoke to the stroke team. The team initially decided not to give tPA.*
However, Tracee remained concerned, and re-examined him a short time later. She picked up on new subtle visual field loss and problems with coordination. She called the stroke team back on her own initiative (telling me of her plan in the meantime). She told them she thought tPA was needed and the stroke physician agreed. She initiated tPA orders with nursing and the patient received the medication within the treatment window. The patient responded incredibly well, was admitted, then discharged – home – a few days later.
I was profoundly impressed by her care at the time and I’ve never forgotten the case. Neither has she. And neither did the patient! He lives on the other side of the country, but stopped by our emergency department six months later specifically to fill out a DAISY award nomination!
Given the extraordinary nature of his presentation and the initiative she took, I firmly believe Tracee’s actions and decision-making made a huge difference in the quality of this man’s life. Had he presented to a different emergency department, tPA may not have been given. He may not be playing golf and living a normal life today.
Not only did Tracee pick up on subtle findings on a challenging stroke presentation, she took initiative in advocating for her patient in a difficult situation. This is EXACTLY the kind of teamwork and patient-centered care we encourage here at Fairfield Hospital and Mercy-wide.
*According to stroke.org (by the National Stroke Association), there is only one Food & Drug Administration (FDA) approved drug treatment for acute ischemic stroke. Tissue plasminogen activator (tPA) is given via intravenous therapy (IV) and works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. tPA should be given within three hours (and up to 4.5 hours in certain eligible patients) of the time symptoms first started.