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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

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