THE SETTING – two warm and sunny September days welcoming more than 50 doctors attending from across the country.
The venue, the President Hotel designed by famous Greek architect Ioannis Vikelas whose legacy is written in the Athens skyline.
On the podium, speakers drawn from the most influential ranks of the Greek stroke community.
The agenda, packed.
The goal? To start a conversation.
It was to be the first ever Angels Day in Greece, and months of thoughtful work had gone into the planning. She wanted it to be about more than learning how to shorten your door-to- needle times, Angels consultant Eleni Panoutsopoulou says. Her intention was to create a community and a network that connected doctors across distances, as well as across disparate levels of experience and access to resources.
The agenda was designed to achieve this, and the presentations tailored to deliver value to both seasoned veterans and to the new kids on the block. For inexperienced doctors from smaller hospitals or remote islands it offered paradigm-shifting insights and education. At the same time, Eleni wanted seasoned doctors from stroke-ready centres to consider whether “perhaps they were trapped in their reality and whether by changing just one detail of what they’d been doing for years they could maximise their impact.”
Twice on day one there were signals that she was succeeding in her community-building goal. One was when a speaker at one of the parallel sessions of multidisciplinary masterclasses observed that they were all “sharing experiences and stories so none of us feels alone, uncertain and afraid”. The other came at the end of a masterclass in CT imaging when the conversation continued unabated as the clock ticked towards dinner time. “I didn’t want to interrupt them,” Eleni says. “It showed the impact we were having.”
Conversation and experience-sharing characterised the two-day event even when it wasn’t on the agenda. Throughout the parallel sessions on imaging, decision-making and the hyperacute phase, questions were asked and answered, struggles and practices shared, problems examined, and solutions offered from the floor.
Dr Lina Paleodimou of Attikon University Hospital kicked off day two with a presentation about the importance of quality monitoring and ways to overcome data collection barriers at hospitals. She was succeeded at the podium by Dr Apostolos Safouris of Athens Metropolitan Hospital and member of the ESO Stroke Unit Certification Committee. Dr Safouris is an advocate for ESO certification who, along with Hellenic Neurological Society president and ESO vice-president Prof Georgios Tsivgoulis, negotiated a certification fee discount for hospitals with ESO Angels platinum and diamond status. Stroke centre accreditation was not an end in itself, Dr Safouris explained. It was about the changes a hospital had to make in order to reach certification, and the impact of those changes on patient outcomes.
For the third session on day two Eleni leveraged the community-building power of storytelling, inviting doctors from three different hospitals to
share their experience of the first stroke patient they treated with thrombolysis. On the stage Dr Georgia Kourtesis of the General Hospital of Serres in Central Macedonia was joined by Dr Christos Maglaras of the General Hospital of Kalamata on the Peloponnese Peninsula, and Dr Galaktion Konstantinidis from the General Hospital of Thessaloniki “G. Papanikolaou”. Their stories resonated with an audience who had all faced a similar moment, and a flurry of questions meant there was barely time for coffee before the start of one of the event highlights – the simulation workshop moderated by Prof Panagiotis Mitsias University of Crete.
Later on day two, a presentation on the FAST Heroes stroke awareness campaign by Prof Hariklia Proios of the University of Macedonia and an awards ceremony presided over Prof Tsivgoulis would conclude Greece’s first Angels Day on a celebratory note. But it was during the simulation that Eleni witnessed the power of community in action.
In case one a 30-year-old female was brought to the ER one hour after experiencing sudden onset of leftside weakness, with an NIHSS of 16. Contra-indications were ruled out and a treatment route swiftly decided.
Case two was of a 75-year-old male who was being evaluated in the ER 75 minutes after symptom onset. The neuro exam showed he was alert and cooperative, but displaying a left facial droop with left arm plegia and left leg paresis. The patient was on unidentfied anti-hypertensive medication and was recovering from bladder surgery as a result of which he had recently stopped taking aspirin. His blood pressure was 200/90 and an ECG showed atrial fibrillation. His NIHSS was 8. The diagnosis was acute ischaemic stroke with severe carotid stenosis.
The room went silent as two experienced doctors, having weighed the evidence, arrived at opposing views about treatment. Doctor #1 was a firm yes, doctor #2 an emphatic no. They were each determined to stick to their decision and defend it with passion. A vigorous debate ensued, lasting more than 10 minutes before doctor #2 was persuaded to switch sides.
The moment was remarkable for its resemblance to everyday life, Eleni says. “These are the kinds of conversation that really take place in hospitals.”
Two things emerged from the discussion that followed. One was that witnessing the exchange had convinced some doctors that change might be needed at their own hospitals. The other was that the impulse to change could have many triggers. It could even come from a member of your community who took the trouble to disagree with you passionately on Angels Day.
