As the state’s first , UofL Hospital meets the highest standards of stroke care, and continually raises the bar. Prompt treatment with intravenous Alteplase (IV t-PA) is associated with better outcomes, lower mortality and shorter length of stay for patients with ischemic stroke. One of the key stroke treatment guidelines established by the American Heart Association and American Stroke Association is the administration of IV t-PA within 60 minutes of arrival at the hospital for patients with ischemic stroke. The staff at UofL Hospital continually works to improve this time, aiming to deliver IV t-PA to eligible patients within 45 minutes.  

Deidra Gottbrath, RN, BSN, leads a team of specialized stroke clinical resource nurses on staff at UofL Hospital to help ensure that eligible stroke patients receive IV-tPA as quickly as possible. It can be challenging to determine whether a patient’s symptoms are due to a stroke or another condition. Gottbrath, who is certified in critical care and stroke care, provides the added resource to help expedite this process.

“From the moment we start participating in care, the ultimate focus becomes treating the stroke. That sounds simple, but there are a lot of complex cases that involve stroke symptoms,” Gottbrath said. “We don’t wait until we are sure it is a stroke before we apply that urgency. We focus on treating every case with stroke symptoms as though it is a stroke until we firmly rule out a stroke and let go of that urgency.”

Paula Gisler, RN, PhD, is director of the UofL Hospital Stroke Program and helped define the stroke clinical resource nurses’ role. “These nurses are a resource to patients and physicians to drive care for all stroke patients. They do whatever it takes to get stroke patients appropriate care to achieve the best outcomes.”

The stroke clinical resource nurse supports emergency room nurses to assess potential stroke patients, facilitate scans, get IV-tPA medication prepared, and work with family members. They keep lines of communication flowing among emergency room nurses, doctors, the stroke team, the radiology staff and other providers.

“We are the string that ties the story together so it makes a complete circle, rather than leaving threads that might be woven together later,” Gottbrath said. “Because we focus solely on that one patient and situation, because that is our priority, we can offer the resource of locating family members to get the full story to get the patient treatment.”

Gottbrath and the other stroke clinical resource nurses follow patients beyond the emergency room, advocating for patients and keeping the lines of communication open throughout their stay. They provide education for patients and their families, as well as bedside nurses who care for stroke patients outside of the stroke unit.

“We are involved in the daily discussions of what type of rehab is appropriate for a patient and communicating that back to the families,” Gottbrath said. “We are there from the scariest moment to looking forward to going home or to rehab. We see the full circle of care.”

Kerri Remmel, MD, PhD, director of the UofL Hospital Stroke Center and chair of the UofL Department of Neurology, says Gottbrath and her colleagues are invaluable assets to stroke care.

“Deidra and the other stroke clinical resource nurses provide an exceptional service to our patients,” Remmel said. “They are vital in keeping the focus on stroke care for those patients and making the connections that have led to even more improvements in the care we provide.”

Door-to-needle times reduced 

Gottbrath and Tina Walsh, RN, BSN, another stroke clinical resource nurse at UofL Hospital, compiled research data showing that since the introduction of stroke clinical operations nurses in 2016, door-to-needle times at UofL Hospital have shortened by an average of 2.5 minutes for eligible patients receiving IV t-PA at the hospital. In addition, eligible patients receiving IV t-PA within 45 minutes of arrival increased from 37 to 49 percent. Gottbrath presented the data at the International Stroke Conference earlier this year.

Although the UofL program does not yet have stroke nurses on duty around the clock, having these nurses in the hospital has led to faster door-to-needle times even when a stroke nurse is not in the building.

“This position has encouraged and educated the staff so that even when we are not physically present, stroke care is fresh on people’s minds – they remember the urgency of it,” Gottbrath said.

Gisler expects UofL Hospital will have a stroke clinical resource nurses on duty around the clock by the end of 2018.

A native of southern Indiana, Gottbrath originally planned to become a physician, but she did not feel as engaged in that career path as she expected. She followed her sister’s suggestion to try nursing and discovered it gave her the interaction with patients that she enjoyed.

“As I delved into it, I felt more connected to nursing,” she said. “The minute I started nursing school I thought, ‘This is what I’ve been missing. This is the connection to medicine I always wanted.’”

“Every day is so different and so challenging but so rewarding. Now I can’t image doing something different.”

Heather Hibbard, BSN, RN, manager of the medical oncology and infusion center at the University of Louisville , is being honored for making a difference in the lives of cancer patients. Hibbard is one of seven health care providers who will be in the spotlight at the Third Annual Commitment to Compassion Luncheon, sponsored by Passport Health Plan, Insider Louisville and the Compassionate Louisville Healthcare Constellation. The event is scheduled for Wednesday, Feb. 28, at the Muhammad Ali Center.

Hibbard uses her training as well as her personal experience to make life a little easier for cancer patients. Her father and grandfather were diagnosed with lung cancer within one month of each other, and passed away one month apart in 2013. Although it was a painful time for her, that experience helps her understand how to improve care provided to the patients at the Brown Cancer Center.

Hibbard says she wants to provide the kind of care for patients and families that she would want to receive. To help make things easier, she developed a lab and line room where patients can have their vitals and lab work done before seeing the physician. This reduced patient wait times by two thirds.

“Cancer does not have to be a death sentence, but the patients need top-notch, nurturing and individualized care,” Hibbard said. “My one goal in life is to make a difference in cancer care – to give others hope that we are doing everything we can as an oncology center. I have a great group of people who want better care for their patients and I help them in reaching that goal.”

It is often little things that make a difference for patients.

“You don’t ever hear, ‘thank you for accessing my port,’” Hibbard said. “But you do hear ‘thank you for being gentle with me,’ ‘thank you for listening,’ ‘thank you for calling home health and getting things set up so my life is a little easier.’”

The Commitment to Compassion luncheon, emceed by television health and science reporter Jean West, will include recognition of the compassionate care honorees, a performance by the West Louisville Boys Choir and a panel discussion on “Innovative and compassionate care in West Louisville.” Reservations are available .

“I witnessed what cancer did to our families. I went home with them to help them with the aftermath of their treatment. I held their hands at the end, and I let them go,” Hibbard said.

Her father and grandfather passed away one month apart in 2013. Although it was a painful time for her, Hibbard began to draw on her personal experience to improve care provided at the UofL Brown Cancer Center.

“I did not know if I was going to be able to walk back in this office at all. But believe it or not, it actually made me stronger,” Hibbard said. “I started saying, ‘What can I do to be a better nurse?’”

As a nurse manager, Hibbard is in a position to make things easier for many of the patients at the Brown Cancer Center. For example, to improve appointment turnaround times, she created a lab and line room where patients can have their vitals and lab work done before seeing the physician. This reduced patient wait times from 60 minutes to 20 minutes.

“She has streamlined a lot of our processes,” said Beth Small, RN, a nurse clinician at Brown Cancer Center. “She lets us do our job as opposed to micromanaging us. Every doctor, every nurse and every patient is different. She gives us the autonomy to address issues and take care of our patients and our physicians the way we need to.”

She also takes the extra steps to help when patients are having more than their share of difficulty.

“She knows that not everyone has fairy tale life. When we have patients in need, she has organized and pulled us together to make sure they have Christmas or whatever they need. Someone might need shoes, someone might need clothes. We have patients who have that much need,” said Small, who was a charge nurse at the cancer center and interviewed Hibbard when she was hired.

Hibbard believes she can help improve care for patients by improving life for the nurses and staff.

“Take care of them, and they take care of the patients,” Hibbard said.

Path to nursing

To help the nurses increase their knowledge, Hibbard began inviting monthly educational speakers. She is familiar with intentional development, having begun her career as a certified nurse’s aide. The nurses she worked with told her she would make a great nurse, but she was apprehensive about nursing education.

After her children were born, however, she made the decision to push herself. She joined the Brown Cancer Center as a medical assistant and started college while all three of her children were still in diapers. First, she obtained an LPN degree, then an RN, and in 2016, she received her BSN.

Now Hibbard mentors other nurses to help them achieve their goals.

“Heather exhibits the role of the servant leader. She grew up as a professional in the Cancer Center, and she now leads by example and works with people where they are as individuals – not just as employees. We have several staff members who have grown under Heather’s leadership and several who are in school,” said Kimberlee Hanna, MBA, BSN, RN, OCN, interim director for medical oncology and infusion at the Brown Cancer Center and Hibbard’s supervisor.

Hanna said Hibbard is constantly working on ways to improve processes within the cancer center, which recently transitioned from management by KentuckyOne Health to University Medical Center.

“She takes problems and looks for different ways to approach them.  This leader always keeps the patient at center of focus,” Hanna said. “As a leader, she is very positive and very focused on the direction the cancer center is going. I’m always encouraged by her level of drive, courage and creativity.”

Hibbard says she wants to provide the kind of care for patients and families that she would want to receive.

“Every patient is so important. I see a glimpse of my father in each one of them. The daughter who is with them, or sister or mother, I see them as me,” Hibbard said. “I’ve been out to make things different so they don’t have to go through the things I went through with my father and my grandfather.”

It isn’t always big things that make a difference, however.

“You don’t ever hear, ‘thank you for accessing my port,’” Hibbard said. “But you do hear ‘thank you for being gentle with me,’ ‘thank you for listening,’ ‘thank you for calling home health and getting things set up so my life is a little easier.’”

In recognition of her exemplary care for patients, Hibbard received the Daisy Award for Exceptional Nurses in April.

“I’ve been a nurse for 36 years and probably the biggest compliment I can give her is I’d let her take care of me any day,” Small said. “She is a wonderful nurse.”