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Romania

Shaping The Future Of Stroke In Romania

They are a team with a dream. Led by the national coordinator Prof Cristina Tiu, neurologists Dr Elena Oana Terecoasă and Dr Răzvan Radu from the Bucharest Emergency University Hospital (SUUB) together with Dr Vlad Tiu from the Elias Bucharest University Emergency Hospital earned their reputation as a “dream team” by participating in training hundreds of healthcare professionals in stroke care and inspiring stroke hospitals and teams in and beyond Romania. Their dedication, leadership and drive for change were recognised at ESOC 2023 in Munich, where they were awarded the ESO Angels Spirit of Excellence Award.
Angels team 15 November 2023
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What is the motivation and the mission?

Dr Elena Terecoasă
We got involved in this project with the firm belief that the treatment of stroke patients in Romania can be significantly improved, just as it happened in other European countries. Initially we wanted to have as many hospitals as possible in the country that could offer intravenous thrombolysis treatment to acute stroke patients. Later on we wanted these hospitals to treat as many patients as possible. Now, we aim for better quality standards and for the improvement of pre-hospital stroke care.

Dr Vlad Tiu
To be clear, the dream team doesn’t mean we are somehow better than others, but rather that sometimes you just happen to meet some very special people along the way and you just click. I wish everyone could experience that profound feeling of happiness and increased productivity you get from being in a team that just feels like a dream. I have always believed we are all responsible for making the place around us a little better. We’re just doing the best job we can.

Dr Răzvan Radu
The objective is simple, though hard to achieve – to build an integrated and efficient stroke network. The mission is more ambitious – to reach treatment rates set out in the stroke master plan, which in a large, sparsely populated country with too few doctors is even more difficult. We are guided by our certainty that we can do better, despite the problems in our healthcare system. We believe that healthcare professionals should shape the healthcare system, not the other way around.

If you could change one thing ...

Dr Elena Terecoasă
I would like to see in every hospital a team of neurologists involved in the treatment of stroke patients. This would brings about a change for
the better locally – both in terms of activity in the neurology, radiology and emergency departments, and in educating the population about the rapid recognition of stroke symptoms.

Dr Vlad Tiu
I have a hard time choosing between better post-acute care or improving access to mechanical thrombectomy in the hyperacute phase. We certainly need a lot more of both. But the most urgent need, with the highest impact, would be significantly increasing access to neuro-interventional procedures.

Dr Răzvan Radu
I would like to see a state-of-the-art transfer system for large vessel occlusion (LVO) cases between existing and future treatment centres and comprehensive centres. Ideally it would combine referral at the prehospital level with software that can confidently define LVO on native CT and immediately activate the transfer protocol.

What has had the most impact?

Dr Elena Terecoasă
Three factors have decisively contributed to the improvement of the treatment of stroke patients in Romania: implementation of a national stroke treatment protocol, regional workshops and the development of the National Treatment Network of stroke patients that involves not only infrastructure, but also a community of doctors who collaborate with trust, ease and efficiency.

Dr Vlad Tiu
Dedicated workshops on site. Each of us faces different obstacles to improving stroke care, so you have to be there and see how things go. Incorporating simulations into these workshops also tends to yield the best and fastest results.

Dr Răzvan Radu
Knowing the staff of a hospital puts you in a position to inspire them – and give them the feeling that they are not alone, but instead part of a national team working together towards the same goals.

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From left, Dr Elena Terecoasă, Dr Răzvan Radu and Dr Vlad Tiu


What stands out?

Dr Elena Terecoasă
In 2017 I took the map of Romania and we coloured the regions where patients with acute stroke could be treated with intravenous thrombolysis in orange and areas where they could not be treated in gray. The result was a map with a gray background on which there were some orange spots. In 2019, I made a new map that had an orange background and only a few gray spots. That was one of the happiest moments of my medical career.

Dr Vlad Tiu
The Angels Awards have done a lot to change our mindset. Stroke care monitoring, registry data analysis, self-reporting (honestly), goal setting. Failing and coming back the next year, more determined, better prepared. It normalised the feedback and showed us where we were in the world. Hospitals in Romania now regularly win diamond, platinum and gold awards. This is something I like a lot.

Dr Răzvan Radu
For me it was one of the first Angels workshops, in 2017. There was a lot of excitement and afterwards doctors started to thrombolyse their first patients all over the country. Also, a very special person from the Angels team told me “not to give up on Romania”. So, I am here. Let’s hope he was right!

What stays with you?

Dr Elena Terecoasă
My favourite events were the first regional workshops in Brașov and Sibiu. However, we cannot talk about these events, which took place when the thrombolysis rate in Romania was 1%, without talking about Ligia Bălănean, the first Angels consultant in Romania. She had fantastic determination and made a huge effort to make the right therapy available to stroke patients in Romania. Ligia Bălănean will always remain the fifth member of the Dream Team.

Dr Vlad Tiu
It was a foggy winter morning, and Răzvan and I were sent to Constanța for an IVT workshop and on-site simulation. We were both residents at the time and I remember the looks of concern and disappointment as we entered the room full of doctors waiting for the “experts”. We somehow got them to play along and by the time we left, I felt that something had changed. Two weeks later, we heard that Constanța had just performed their first thrombolysis. They’ve been doing it ever since.

Dr Răzvan Radu
I was doing a simulation with Vlad in Constanța. Vlad was playing a family member like a real actor, creating a lot of obvious problems for the doctors involved. At that time, thrombolysis was not performed in Constanța. When they successfully started tPA, you had 30 people looking at you saying and thinking, “That’s it? It’s that easy?”. Constanța went on to do a 7% tPA rate in their first year and I personally find it amazing. Thank you Angels for giving us this opportunity.

 

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