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Hands-On Hospitalists Plus Telemedicine Improve Stroke Outcomes

Publish date: May 23, 2011

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A Likely Model for Stroke Care

Neurologists are

abandoning hospital practice in large numbers, and hospitalists often feel ill

prepared to care for stroke patients. A telestroke unit is a natural solution

to this problem.

Declining reimbursement

and a perception of increased liability have driven neurologists away from

hospital practice. Although the neurohospitalist movement is a partial answer,

there are not enough of these physicians at present, and particularly not in

small communities and hospitals. Telestroke leverage this resource, combining

the strengths of the neurologist in diagnosis and evaluation with the

hospitalists’ skills in inpatient care. A dedicated vascular neurologist or neurohospitalist

is an ideal partner, but there simply aren’t enough of these practitioners at

present. Telestroke is, therefore, an excellent solution.

This study demonstrates

the power of a telestroke/hospitalist partnership in improving stroke-care

processes and outcomes. I expect this model to become an even more important

part of inpatient neurology care in the future.

David Likosky, M.D.,

is a neurohospitalist and director of the stroke program at Evergreen Hospital

in Kirkland, Wash.


 

FROM THE ANNUAL MEETING OF THE SOCIETY FOR HOSPITAL MEDICINE

Ten patients qualified for tissue plasminogen activator treatment, with TPA given up to 4.5 hours past the last known time of being well. Dr. Godamunne noted that in the prior 2 years, no stroke patients admitted to South Fulton received TPA.

The increase in diagnoses, coupled with demographic factors, speaks to the enormous health problem in the South Fulton community, Dr. Godamunne said: 80% of the patients treated at the new stroke center were black – a known high-risk group for stroke.

"The need for acute and preventive stroke care was not being met in this community of 500,000, in part because patients had to travel an additional 30-45 minutes to a stroke center. In my hospitalist group, stroke was not even in the top 20 of our diagnoses – now it’s number 4, and the impact on us and the hospital has been huge."

In the comparison, mortality was slightly – but not significantly – lower at South Fulton (3% vs. 7%). "This was probably because we did not admit patients with intracranial hemorrhage," Dr. Godamunne noted. Patients presenting with suspected intracranial bleeding were taken to a sister hospital with constant neurosurgical capability.

Among the primary stroke care core measures, South Fulton stacked up well, matching or exceeding the aggregate in all eight measures, with no statistically significant differences.

The experience shows that a hospitalist can build and lead a stroke center, Dr. Godamunne said.

"Patients who were at a higher risk for stroke based on race and demographics can realize the benefits of thrombolytics and all the long-term preventive benefits of meeting all other stroke center guidelines."

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