Creating and Sustaining the Greater Cincinnati / Northern Kentucky Stroke Team

1. Creating and Sustaining the Greater Cincinnati / Northern Kentucky Stroke Team

2. GC/NK Stroke Team History • Originated in 1982 as a collaboration between the Departments of Neurology and Emergency Medicine • Original goal was to “Maximize stroke patient outcome by delivering evidenced-based effective, efficient and safe stroke care throughout pre-hospital and acute hospitalization to all stroke patients in the Tri-state region.” (Judy Spilker)

3. = Greater Cincinnati / Northern Kentucky Stroke TeamA Community Resource

4. GC/NK Hospital Network • Research Network 15 Hospitals • 1 University • 3 Teaching • 11 Community • Also provides acute stroke phone consultation and referral for 20 regional hospitals

5. GC/NK Stroke Team Elements • Acute treatment physicians • Nurse coordinators • Neurosurgeons and neuroradiologists • Clinical fellows in neurology and emergency medicine • Biostatistics / Grant support staff • Basic science researchers • EMS personnel

6. GC/NK Stroke Team Personnel Roles • Physicians • Provide acute stroke care • Develop clinical research • Interface with hospital medical staff • Nurse coordinators • Treatment infrastructure at each hospital • Site study coordination • Data collection / patient follow-up • Stroke care delivery quality assurance

7. GC/NK Stroke Team Physicians • Interventional Neuroradiology • Tom Tomsick, MD • Mary Gaskill-Shipley, MD • Neurosurgery • Mario Zuccarello, MD • Andrew Ringer, MD • Current Fellows • Peter Panagos, MD • Neurology • Joe Broderick, MD (Director) • Daniel Woo, MD • Brett Kissela, MD • Dawn Kleindorfer, MD • Alex Schneider, MD • Dan Kanter, MD • Emergency Medicine • Art Pancioli, MD • Edward Jauch, MD MS

8. GC/NK Nurse Coordinators Judy Spilker, RN Laura Sauerbeck, RN Rosie Miller, RN Janice Carrozzella, RN Kathy Alwell, RN Irene Ewing, RN Ann Geers, RN Diane Oberschmidt, RN Colleen Reynolds, RN Pam Schmit, RN Theo Nodler, RN Diana Goins, RN

9. GC/NK Stroke Team Mechanics • Single pager number for entire team • Stroke Team members respond to the local hospital • Stroke Team physician responsible for initial treatment decisions • Treated patients admitted to local hospital in conjunction with primary care physician • Patient care assumed by PCP after first 24 hours

10. ACUTE STROKE TEAM CONTACTS Joseph Broderick, MD Office: 558-2957 Pager: 691-0764 Cell: 919-5404 Home: 891-3532 Daniel Kanter, MD Office: 558-5043 Pager: 249-8738 Cell: 919-5403 Home: 792-0051 Art Pancioli, MD (Emer Med) Office: 558-8103 Pager: 577-0994 Cell: 604-4436 Home: 754-1064 Tom Tomsick, MD (Neurorad) Office: 584-0607 Pager: 269-4478 Cell: 520-0139 Home: 561-2115 Janice Carrozzella, RN Office: 558-4789 Pager: 589-5502 Cell: 604-3561 Home: 352-0847 Brett Kissela, MD Office: 558-5445 Pager: 249-7168 Cell: 678-8180 Home: 793-6553 Andy Ringer, MD (NeuroSurg) Office: 558-1290 Pager/Cell: 256-7444 Admin Asst: 475-8662 (Karen) Daniel Woo, MD Office: 558-2705 Pager: 249-3112 Cell: 509 2214 Home: 794-1822 Mary Gaskill-Shipley, MD (Neurorad) Office: 584-0605 Pager: 269-4354 Cell: none Dawn Kleindorfer, MD Office: 558-5328 Pager: 691-1002 Cell: 919-5407 Home: 793-4362 Alex Schneider, MD Office: 558-1480 Pager: 554-5315 Cell: 859-322-1742 Home: 731-0360 Mario Zuccarello, MD (Neurosurg) Office: 558-5387 Pager: 269-2344 Cell: Admin Asst: 475-8624 (Janine) Ed Jauch, MD (Emer Med) Office: 558-0474 Pager: 590-3191 Cell: 604-4434 Home: 936-9332 Pete Panagos, MD (Emer Med) Office: 558-0106 Pager: 230-9465 Cell: 503-3743 Home: 871-9047 Judy Spilker, RN (Emer Med) Office: 558-5430 Pager: 249-0517 Cell: 604-4438 Home: 385-6652 Call 844-7686 TIME IS BRAIN GC/NK Communication Tools

11. GC/NK Tenets • Follow the 3 A’s Affable Available Able • Provide feedback to entire “Chain”

12. Regional Hospital Responsibilities • Hospital • Maintain “Chain of Recovery”, pathways • Emergency Nursing • Identification of stroke symptoms • Emergent triage • Assess patient, coordinate care, administer drugs • Emergency Physicians • Assess and verify onset time • Initial medical management • Contact Stroke Team early

13. Additional GC/NK Roles • Education: • Public and EMS stroke education • Community physician education • Patient Care: • Care pathways and protocols for hospitals • National promotion of improved stroke care • Research: • Clinical trials • Epidemiology • Basic science

14. Benefits of GC/NK System • Clinical • The patient gets expertise in stroke care and exposure to latest stroke therapies • The local E.D. physician gets help • The local hospital gets to keep the patient, unless they cannot provide necessary service • Local neurologists get a consult without taking call in the middle of the night

15. Benefits of GC/NK System • Research • Patient population of 1.5 million people • Multiple sites for multiple projects • Representative population for epidemiologic research • Integrated system for both ischemic and hemorrhagic stroke • Training • Large system allows for excellent fellow training

16. Limitations of GC/NK System • Clinical • Variability in post-stroke treatment • Labor intensive and not supported by reimbursement • Unique due to competition in health care systems • Removes community physicians (emergency medicine and neurology) and residents from initial treatment process

17. Limitations of GC/NK System • Research • In-servicing multiple sites • Duplication of paperwork (IRB, informed consents, pharmacy, etc) • Need for larger amounts of study drug or additional medical devices • Transportation of clinical specimens

19. “When the end of the world comes, I want to be in Cincinnati because it's always twenty years behind the times."