Strokes and Cerebral Haemodynamics
The Stroke and Cerebral Haemodynamics Unit provides excellent comprehensive care to patients who have had a cerebral infarction, known as a "stroke" or "embolism". The main aspects of the Unit’s activity are: to promote innovation, continuous improvement of quality care, teaching, research and clinical management.
Our Unit’s mission is to achieve the highest quality healthcare standards through defined quality objectives. We aspire to make our unit a centre for clinical management providing comprehensive, multidisciplinary care for strokes in the acute phase, focused on achieving a high level of excellence as a level three centre for the resolution of the most complex cases of neurovascular pathology.
Strokes are the second most common cause of death in Spain, and the most frequent cause of disability in adults around the world. Most strokes are caused by blood clots that block a blood vessel in the brain preventing blood flow. The progress we have made in recent years has secured our place as leaders both locally and nationally, thanks to the development of innovative and effective treatments that reduce the social and economic burden of strokes in our society.
Staff at the Stroke Unit share the values of commitment, teamwork, innovation and vocation to serve, all in order to help achieve the following strategic objectives:
- To reduce the time between the onset of symptoms and effective cerebral reperfusion (restoration of the blood flow to the brain).
- To increase the number of reperfusion treatments to 25% (currently 14%).
- To reduce the risk adjusted average length of stay by optimising triage and referring patients by telemedicine.
- To ensure early multidisciplinary assessment of intracranial haemorrhages.
- To consolidate leadership of the Unit in procedures for vascular neuro-intervention.
- To integrate early rehabilitation protocols in stroke patients.
- To offer a comprehensive training programme for stroke nursing.
- To promote a cross-cutting approach to exchange knowledge among the professionals involved.
- To apply and evaluate the Unit’s Quality and Sustainability Plan.
Our team is made up of eight vascular neurologists, three neuro-interventionists, two stroke nurses per shift, rehabilitators and nursing assistants. We work closely with professionals from other specialties such as neuroradiology, cardiology, neurosurgery and rehabilitation. This means that in 80% of cases, only 12 hours pass between the arrival and admission of patients, which allows patients to be diagnosed in 48 hours in 80% of cases, reducing the average stay to under 2.9 days, despite receiving highly complex cases.
Our multidisciplinary team can monitor the minute-by-minute progress of patients admitted with acute strokes thanks to the new beds with continuous haemodynamic monitoring systems. We were the first Unit in Spain to have this type of bed with telemedicine, which means we can monitor the patient's condition 24 hours a day. In addition, two of these beds are for monitoring cerebral and clinical haemodynamics for transient ischemic attacks, meaning we can assess and diagnose patients in less than 24 hours. Furthermore, the Department always guarantees the availability of a bed for emergencies.
We were also the first centre to instate Code Stroke in 1998, as well as pioneering the implementation of the neurovascular systematic diagnosis using Doppler ultrasound, which applies ultrasound to detect blood flow, in our emergency ward. Thus, we are proud to have contributed significantly to the development of treatment strategies such as sonothrombolysis, and we have received international recognition for our leadership in multicentre clinical studies.
Currently, in keeping with our commitment to innovation, we are the first functional unit to integrate vascular neuro-intervention as part of the structure of the Stroke Unit. This functional model means we can substantially reduce time needed for brain reperfusion and optimise patient care and management of treatment, while maintaining the quality standards of the Stroke Unit in the neuro-intervention room.
The high level of training and experience of our staff means we can carry out non-invasive neurovascular examinations 24 hours a day. Therefore we provide high-quality urgent stroke care, not just in our area of reference, but also in other centres that do not have a neurologist. In such cases, we use telemedicine.
Technology is a tool for us to improve the health and quality of life of our patients. A good example of this is the Farmalab mobile application, for patients who have returned home after a stroke. This application helps patients receive personalised, continuous supervision in following the medical guidelines while vascular risk factors are monitored.
Another mobile application, Mefacylita, can be used to share videos and schedule rehabilitation and occupational therapy activities using a touch screen device. The Teleictus Mòbil system, on the other hand, allows assessment and monitoring of patients by video conference before they reach the Hospital.
We are also pioneers in using the latest equipment, such as a Doppler ultrasound unit, an echocardiography unit and a vascular neuro-interventionism room all made available to the medical team working there. We also have a gym for early rehabilitation. The facilities, located on the second floor of the General Hospital, cover some 294 m2. Hospital wards have been designed to meet the needs of patients with limited mobility who need to be transferred. We also have technology at the head of the patients’ beds to evaluate the flow of blood to the brain of the patients non-invasively, and this information is controlled at all times using a centralised system, meaning we always know the state of blood flow in the brain.
Portfolio of services
Urgent neurological clinical assessment, available 24 hours a day 7 days a week (24/7).
- Code Stroke available in- and out-of-hospital 24/7
- Continuous video monitoring of acute strokes, hospitalisation in the Stroke Unit and Vascular Neuro-intervention, available 24/7
- Urgent multimodal systemic haemodynamic monitoring, 24/7
- Doppler ultrasound of supra-aortic patients, 24/7
- Transcranial Doppler ultrasound, 24/7
- Prehospital sonogram diagnosis (EMS ambulances) of ischemic and haemorrhagic stroke
- Continuous and real-time monitoring of arterial recanalisations, 24/7
- Continuous outpatient monitoring of blood pressure
- Urgent cardiac ultrasound in patients with acute stroke
- Telemedicine: neurological assessment, evaluation and treatment of reperfusion in provincial hospitals
- Treatment of systemic reperfusion (endovenous thrombolysis)
- Vascular neuro-interventionism
- Identification, diagnosis and selection of patients with candidates for decompressing hemicraniectomy
- Clinical trials of treatments and experimental procedures in the acute stroke phase
- Continuous outpatient monitoring of cardiac arrhythmia
Fermín Fernández Álvarez, Porter Coordinator, explains the importance of the role these professionals play in the hospital. After 36 years at Vall d’Hebron, Fermín is a real master of the ways things are done. He says that a porter has to combine humility, discretion and safety with a single goal: that patients receive human and friendly treatment.
The constant search for excellence is part of Hospital Vall d’Hebron’s nature. The biggest hospital in Catalonia and the leader in many fields, headed since February 2015 by Dr. Vicenç Martínez Ibáñez, who has a close personal and professional relationship with the Hospital. Dr. Martínez Ibáñez says that if Vall d’Hebron did not exist, it would need to be invented. The current director trained at the hospital, where he was one of the protagonists of an historic moment: the first paediatric liver transplant in Spain. Now, he is committed to continuing this legacy and, always putting the patient first, achieving excellence across all staff.
The Neonatology Department’s Sibling Project is a workshop for the siblings of new-born babies admitted to the Paediatric Intensive Care Unit in the Vall d’Hebron Maternity and Children's Hospital. Through simulated games and situations, the project prepares them to get used to seeing their younger siblings in a hospital medical setting.
Vall d’Hebron University Hospital’s kitchen serves more than 1,000 meals a day, twice a day, not counting breakfast. A reality that José Parrilla and Carmina Esteban know all too well.From three kitchens to one and from coal to gas. That is how the hospital’s catering service has evolved. A place where the needs of each patient must be taken into account and where there is room for small, juicy anecdotes.
The former head of the Thoracic Surgery Department, Dr. Mercè Canela, recently retired, recalls the important evolution of the Department to become a leader in Spain and a lung transplant pioneer. A task made possible thanks to collaboration with professionals from other departments, an added value in the personal and team environment.
Rosalia Moure arrived at Vall d’Hebron University Hospital in 1967. She spent her entire working life in the linen and laundry department of the Hospital. Rosalia Moure has witnessed the Hospital’s big transformations, from dictatorship to democracy and from analogue to digital systems.
Dr. Josep Sánchez de Toledo Codina, head of the Paediatric Haematology and Oncology Department, tells us about a Department that has laid the foundations for the specialism in Spain. He also remembers the evolution of transplants from haematopoietic stem cells and progenitors, from the beginning, buying the material at a shop in Barcelona city centre, to the more than 1,200 transplants that have now been performed.