I AM Patient Safety 2022 Improving Diagnosis Award Winner

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Joyce Litwak, RN

​Lehigh Valley Health Network


A patient who was admitted and treated for an isolated hip fracture was to be discharged, but because her COVID test result was not back in time she was rescheduled to leave the next day. Although Joyce Litwak, RN, knew the patient was set to leave and already had a diagnosis of an isolated hip fracture, she completed a full assessment anyway—and found the patient to have left upper extremity weakness, a telltale sign of stroke. Litwak notified the attending who assessed the patient and noticed some facial droop. A stroke alert was called and subsequent diagnostic scans revealed a severe intraluminal carotid artery (ICA) thrombus. Due to the patient’s inability to receive tissue plasminogen activator (tPA), a “clot buster” drug, without intervention she was almost certain to have a massive and likely fatal stroke. The patient was in the operating room a short time later to remove the ICA clot.​

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