This is how you move a building in three steps:
One, cut openings in the foundation and install steel beams for structural support. Two, install hydraulic jacks under the structure and connect them to a system that monitors pressure and keeps the building level. Three, jack it up, install platforms on wheels below, and commence the slow crawl to its new destination.
In 1975, the people of Most, a town near the northwestern border of the Czech Republic, had to move their Gothic church more than 800 meters to a new location to make way for a coal-mining operation. The Church of the Assumption of the Virgin Mary weighed 12,700 tons. At an average speed of 2,16 cm per minute, she reached her destination after 28 days, bringing pride to the Czech government and winning Most a mention in the Guinness Book of World Records.
It was, at the time, the heaviest building ever to have been moved on wheels.
Hearing this you might ask to yourself, if a town can do that, what else might they be capable of? Which brings us to the story of Hospital Most, and how to become an award-winning stroke centre in three steps.
Etapa 1: Find your stroke champion.
Before Dr Ján Macko came to Hospital Most, he was lead physician of the stroke unit at nearby Hospital Chomutov where, having heard of the ESO Angels Awards programme, he put his weight behind a campaign to optimize the stroke pathway and improve outcomes for stroke patients. As a result Hospital Chomutov won three consecutive diamond awards, and in 2020 Dr Macko accepted an offer to join Hospital Most which was, at the initiative of the regional healthcare provider Krajská zdravotní, a.s., to re-establish its stroke programme[LM1] .
Arriving in September 2020, Ján Macko was told he had until March 2021 to create a stroke protocol and assemble and train a stroke team. With the backing of the chief neurologist[MJ2] [LM3] Dr Stanislav Slavík and generous support from his colleague Dr Jozef Sirovič, he got to work straightaway, sharing his experience with his new colleagues and rolling out an education programme that included Angels stroke nurse certification training for every nurse in the neurology ICU.
The emergency nursing staff, as the first point of contact for patients, likewise received instruction in using the FAST test to detect stroke, and what actions to perform after alerting the neurologist on call. Dr Macko was leaving no stone unturned.
Etapa 2: Practice, practice, practice.
With a certified stroke centre accreditation still pending, the new stroke unit at Hospital Most was ready for full action by February 2021, one month earlier than planned. Official sanction from the ministry of health came in October, the same month Angels consultant Robert Havalda was invited to conduct a simulation that was to be a test of teamwork and time.
“They were already quite fast,” says Martin Liptay who stepped into Robert’s shoes last September. “But they still managed to reduce their door-to-needle time from 25 to 15 minutes.”
Over the next year, five young physicians were trained to provide acute diagnostics and therapy within the stroke unit, and gradually integrated with the stroke team. When at the start of 2023 the first of them was ready to start treating stroke patients independently, it was Martin who traveled up to Most for a fresh round of simulation training.
Martin together with Dr Macko had prepared two scenarios – one in which the patient arrived via EMS with prenotification, and one where they were brought to the emergency department by their family. With door-to-needle times of 18 and 13 minutes respectively, and all the key priority actions recommended by Angels implemented as part of the pathway, the exercise boosted the confidence of both the newly qualified Dr Vasyl Uhrynchuk and his team.
One month later on 14 February, Martin returned to Most where four more physicians were ready to get their wings. During four simulations, Drs Michal Antonín, Serhii Syniuha, Svitlana Tkach and Volodymyr Shuranov each managed a different clinical case in world-class door-to-needle times between 13 and 15 minutes.
Dr Macko and Martin were now confident that every stroke patient treated at Hospital Most would receive the same high standard of care no matter who was on call.
Etapa 3: Measure performance and keep improving.
In the Czech Republic, comprehensive data for all stroke patients is collected twice a year, in March and October, and reported in RES-Q. For Hospital Most, therefore, the year 2022 brought the first opportunity to measure their performance against the guidelines-based criteria for the ESO Angels Awards.
When the award-winners from the Czech Republic were announced for 2022, Hospital Most was among them. In the two months under consideration they had admitted 64 stroke patients, of whom 22% were eligible for recanalisation. The median door-to-needle time was 16 minutes, and 85% of patients were screened for dysphagia.
In all but two measures (recanalisation rate and dysphagia), Hospital Most had met the criteria for a diamond award. While deservedly proud of their platinum status, it was an opportunity to scrutinise their performance and target areas for improvement.
Dr Ján Macko had meanwhile succeeded Dr Slavík as chief neurologist but continues to work closely with his colleague who now heads up the emergency department, while Dr Sirovič runs the cerebrovascular consulting centre for stroke patients. In their pursuit of a diamond award, they knew exactly what to do.
Step 1: A member of the Angels nurses steering committee from the region’s only large comprehensive stroke centre in Ústí and Labem, had been invited to provide training on post-acute nursing care including dysphagia diagnostics, GUSS screening and patient positioning.
Etapa 2: Next, the hospital will work with regional and local EMS services to improve stroke symptom recognition so more patients will arrive within the time window for recanalization.
Etapa 3: They will reach out to local GPs to ensure patients are referred to the stroke centre, and to support secondary prevention interventions and post-stroke rehabilitation.
Martin is confident Dr Ján Macko and his team will soon be recognised for providing the highest level of care. Reaching diamond status should be well within the reach of a town that has already shown that where there’s a will there’s a way.
