Best in Class: Armed with the latest technologies, Munson seeks top stroke center certification

Munson Medical Center, which already offers the most extensive stroke treatment services in northern Michigan, is seeking to become certified as among the best in the country for that specialty.

The hospital is preparing its application to The Joint Commission to become a Comprehensive Stroke Center, certifying it as having specific abilities to treat the most complex stroke cases.

It’s the highest stroke center designation by The Joint Commission, which accredits and certifies health care organizations and programs.

Munson would join a dozen other large hospitals in the state that have achieved the certification, all located in southern Michigan. Munson expects to submit its application by September. The hospital has been certified as a primary stroke center since 2012.

Rajah

“We provide comprehensive care already,” said Dr. Gary Rajah, director of Munson Healthcare’s Endovascular Stroke Program. “We treat hemorrhagic and ischemic strokes, but certification gives us third-party recognition we are on par with treatment outcomes and research with other Comprehensive Stroke Centers.”

A hemorrhagic stroke occurs when a blood vessel ruptures, often because of an aneurysm, and causes bleeding in the brain. It is far less common than an ischemic stroke, which results from a blood clot that blocks or narrows an artery leading to the brain.

Rajah, a neurosurgeon, is performing minimally invasive surgical procedures on stroke and aneurysm patients that weren’t available locally before he arrived in May of 2020.

Becoming certified as a Comprehensive Stroke Center will help northern Michigan residents “feel safe that they have this level of service in their backyard,” Rajah said.

Connie Christophersen, a retired teacher who moved to Traverse City from Indiana four years ago, said her experience at the hands of Rajah, his staff and Munson caregivers have made her a believer in the quality of Munson’s stroke program.

Christophersen and her husband were packing their car to spend Christmas with family in Indiana on December 23, 2020 when she got a shocking phone call from Dr. Corey Treadway, a Traverse City ear, nose and throat specialist.

Christophersen had earlier seen Treadway because of hearing loss in her left ear. An MRI he ordered ruled out any serious cause for the hearing loss. But the imaging test found a large brain aneurysm that could have killed her had it gone undetected. She decided it was too risky to travel to Indiana.

“It took a while to reconcile the news,” she said. “(Treadway told me to) try to control coughing, don’t lift anything, just stay as calm as possible and be certain not to fall.”

Treadway immediately referred Christophersen to Rajah.

Guided by one of Munson’s two Siemens biplane angiography imaging units – the only ones in northern Michigan and among the few in use in the country, the hospital said – Rajah inserted what is called a pipeline stent with coils in the artery leading to the brain. The procedure is designed to shrink and ultimately close the aneurysm.

“Dr. Rajah made it clear a wait-and-see approach wasn’t feasible due to the aneurysm’s size,” Christophersen said. “He said the chances were 35-40% of a having an event in a year or so without the procedure.”

She said Rajah emphasized she could seek a second opinion and recommended the Mayo Clinic, Cleveland Clinic and the University of Michigan.

But based on her interactions with Rajah – all through telemedicine visits because of the pandemic – and a video she watched about a Munson patient who underwent the same procedure she needed, Christophersen said she felt confident about him performing the operation.

Christophersen also said she feared having a ticking time bomb in her head made it too risky to travel another medical center for care.

Rajah “is a physician who possesses extraordinary talent, humility and empathy,” she said.  “Calls were quickly returned and information was explained until I fully understood all aspects of my situation. His entire team showed the same compassion and kindness.”

Christophersen underwent the stent and coil procedure on Jan. 14, 2020. More than a year later, an angiogram showed the aneurysm had shrunk significantly. She said Rajah told her he expects it will disappear within a few months.

“I’m so glad we stayed here,” Christophersen said. “I don’t think I could have received better care anywhere else.”

Bruining

The number of stroke patients treated at Munson has jumped 60% since 2020, the year Rajah joined the medical center’s staff. Munson treated 900 stroke patients last year, up from 536 in 2020, said Dr. Kersti Bruining, medical director of Munson’s stroke program.

Rajah began performing mechanical thrombectomies, a minimally invasive procedure to remove a clot from a patient’s artery, in August 2020. He performed 31 thrombectomies that year, jumping to 106 last year.

Munson is seeing a substantial increase in the number of stroke patients for several reasons, hospital officials said. They include a growing Grand Traverse area population, particularly among retirees who are most at risk of having a stroke. The median age of a stroke patient is 74 years, Bruining said.

New imaging technology allows Rajah to remotely evaluate arriving stroke patients at Munson Healthcare’s seven smaller hospitals to determine if they need to be immediately transferred to the Traverse City hospital for a procedure.

“We are linking all our emergency facilities with (artificial intelligence) software,” he said. “I can see in real time the CT image and determine if patients need to be sent here immediately by helicopter. That’s a big improvement for northern Michigan.”

Time is of the essence in treating stroke patients. Every hour stroke treatment is delayed reduces the chance of a patient returning to functional independence by nearly 8%, Bruining and Rajah said.

Munson also is seeing more patients who put off medical treatment for other conditions because of the COVID pandemic that led to a stroke, Bruining said.

And new technologies allow the hospital to treat stroke patients who would have otherwise been transferred to other medical centers.

Prior to Rajah’s arrival, Munson estimated as many as 250 stroke patients a year in northern Michigan were being transferred to downstate hospitals for neurosurgical procedures.

Bruining also credited Munson’s education efforts in getting more people to seek treatment when they think they are having a stroke.

Strokes are the fifth leading cause of death and the top reason for disability. More advanced stroke treatments produce better outcomes benefits the entire community, she said.

“It’s really exciting that we’re growing the way we are,” Bruining said. “We’ve spent a lot of effort educating the community to recognize symptoms of a stroke.”

Munson’s stroke program is growing so quickly that Rajah foresees Munson eventually needing a separate bricks-and-mortar facility to treat and rehabilitate stroke patients.

“That’s definitely on my list of things down the road,” he said. “We have limited beds in the hospital. I think the future vision will probably include a free-standing facility.”

Signs of a Stroke: Munson says think BEFAST to spot a stroke

Balance: Lost balance?

Eyes: Lost vision?

Face: Drooping or uneven?

Arms: Weakness on any side?

Speech: Slurred or strained?

Time: Call 9-1-1 immediately.

 

 

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