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How A New Bulgarian Stroke Ready Hospital Saved Its First Life

In the Veliko Tarnovo region, MDHAT “Stefan Cherkezov” was the first hospital to transform itself into a stroke-ready centre.
Angels team 25 August 2021

An autumn afternoon in a small town about 40 km from Veliko Tarnovo. There is a loud thud, something falls. A middle-aged woman sees her husband lying helplessly on the ground. She immediately recognizes the symptoms of a stroke and calls an ambulance.

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After about 30 minutes they are already at the nearest regional hospital -– MDHAT “Stefan Cherkezov” in Veliko Tarnovo –  and the woman asks for her husband to be taken to Sofia for treatment. The hospital team explains that they would grant her request, but it would take more than 2 hours to transport her husband to Sofia, and once they arrived it would be too late to treat him. In the time lost, millions of nerve cells in his brain would die.

Recently, however, stroke treatment protocols have been established at the Veliko Tarnovo Hospital and, if she trusts them, they will take care of her husband’s condition according to the best international practices.

One year after the severe brain accident her husband is back at work, playing sports regularly and learning a new language, and the woman is more than grateful to the team at the hospital for helping her beloved husband.

For many years MDHAT “Stefan Cherkezov” had no established protocol for acute treatment of ischemic stroke. But the hospital’s ambitious team decided to change that, and in 2019 it became one of the country’s leading stroke treatment centers.

Along the way, there were many difficulties and complex tasks to be solved. For example, the neurology department is located a few kilometers away from the main building of the hospital where patients arrive, and only with very good organization were they able to achieve rapid assessment and treatment.

In order to give a chance at life to as many patients as possible, a strict organization was established with the active support and strong motivation from the Department of Anesthesiology and Intensive Care. Representatives of both departments drew on the experience of the team at the University Hospital “St. Anna” in Sofia, attending its ‘Stroke Academy’ supported by the Angels Initiative.

The medical specialists from Veliko Tarnovo were among the most active participants during the National Meeting of the Angels Initiative in September 2019.

At the end of the same year, they hosted a regional meeting with the EMS teams aiming to optimize the pre-hospital organization in the region. With the accumulation of more and more experience, they discovered the need for analysing the stroke care quality. In order to organise their data, the team started using the RES-Q platform and implemented strict quality monitoring for each admitted patient at the stroke unit. By 2020 MDHAT “Stefan Cherkezov” was among the 15 most active hospitals in Bulgaria in terms of stroke treatment, and their success served as motivation for other hospitals in the Veliko Tarnovo region to become Stroke Centres.

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In 2019 in the district of Veliko Tarnovo, another hospital started its activity in stroke care – the MHAT “St. Ivan Rilski ”, Gorna Oryahovitsa. The ambition to take this direction came primarily from the director of the hospital, a neurologist by specialization, but it was quickly adopted by the team of the neurology department as well. In March 2019, three specialists from nearby hospitals with experience in the treatment of stroke arrived in Gorna Oryahovitsa to share their knowledge. The guests from MHAT Silistra and MHAT Targovishte shared their experience and recommendations during a multidisciplinary meeting with the teams at MHAT “St. Ivan Rilski ”.

During the meeting, both of the organisations’ patient-treatment paths were discussed as well as real clinical cases. Special attention was paid to the topic of CT imaging as an integral part of the clinical decision-making process. The discussion was very active and turned out to be very fruitful because shortly afterwards the first patient with ischemic stroke was treated.

On the way to optimize the process, many more steps were taken by the team representatives of the hospital. They spent two days in MHAT “St. Panteleimon”, Plovdiv, in order to gain knowledge and exchange experience from the point of view of a team with several treatment options. Later in 2019, MHAT “St. Ivan Rilski” sent a representative to the national meeting of Angels, where an environment for even more in-depth discussions was created.


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