Creating and Sustaining the Greater Cincinnati / Northern Kentucky

Stroke Team

GC/NK Stroke Team HistoryGC/NK Stroke Team History

• Originated in 1982 as a collaboration Originated in 1982 as a collaboration between the Departments of Neurology and between the Departments of Neurology and Emergency MedicineEmergency Medicine

• Original goal was to “Original goal was to “Maximize stroke Maximize stroke patient outcome by delivering patient outcome by delivering evidenced-based effective, efficient and evidenced-based effective, efficient and safe stroke care throughout pre-hospital safe stroke care throughout pre-hospital and acute hospitalization to all stroke and acute hospitalization to all stroke patients in the Tri-state region.”patients in the Tri-state region.”

(Judy Spilker)(Judy Spilker)

Greater Cincinnati / Northern Kentucky Greater Cincinnati / Northern Kentucky Stroke TeamStroke Team

A Community ResourceA Community Resource

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GC/NK Hospital NetworkGC/NK Hospital Network

• Research NetworkResearch Network15 Hospitals15 Hospitals• 1 University1 University• 3 Teaching3 Teaching• 11 Community11 Community

• Also provides acute Also provides acute stroke phone consultation stroke phone consultation and referral for 20 and referral for 20 regional hospitalsregional hospitals

GC/NK Stroke Team ElementsGC/NK Stroke Team Elements

• Acute treatment physiciansAcute treatment physicians

• Nurse coordinatorsNurse coordinators

• Neurosurgeons and neuroradiologistsNeurosurgeons and neuroradiologists

• Clinical fellows in neurology and emergency Clinical fellows in neurology and emergency medicinemedicine

• Biostatistics / Grant support staffBiostatistics / Grant support staff

• Basic science researchersBasic science researchers

• EMS personnelEMS personnel

GC/NK Stroke Team Personnel RolesGC/NK Stroke Team Personnel Roles

• PhysiciansPhysicians– Provide acute stroke careProvide acute stroke care– Develop clinical research Develop clinical research – Interface with hospital medical staffInterface with hospital medical staff

• Nurse coordinatorsNurse coordinators– Treatment infrastructure at each hospitalTreatment infrastructure at each hospital– Site study coordinationSite study coordination– Data collection / patient follow-upData collection / patient follow-up– Stroke care delivery quality assuranceStroke care delivery quality assurance

GC/NK Stroke Team PhysiciansGC/NK Stroke Team Physicians

• NeurologyNeurology• Joe Broderick, MD (Director)Joe Broderick, MD (Director)• Daniel Woo, MDDaniel Woo, MD• Brett Kissela, MDBrett Kissela, MD• Dawn Kleindorfer, MDDawn Kleindorfer, MD• Alex Schneider, MDAlex Schneider, MD• Dan Kanter, MDDan Kanter, MD

• Emergency MedicineEmergency Medicine• Art Pancioli, MDArt Pancioli, MD• Edward Jauch, MD MSEdward Jauch, MD MS

• Interventional NeuroradiologyInterventional Neuroradiology• Tom Tomsick, MDTom Tomsick, MD• Mary Gaskill-Shipley, MDMary Gaskill-Shipley, MD

• NeurosurgeryNeurosurgery• Mario Zuccarello, MDMario Zuccarello, MD• Andrew Ringer, MDAndrew Ringer, MD

• Current FellowsCurrent Fellows • Peter Panagos, MDPeter Panagos, MD

GC/NK Nurse CoordinatorsGC/NK Nurse CoordinatorsJudy Spilker, RNJudy Spilker, RNLaura Sauerbeck, RNLaura Sauerbeck, RNRosie Miller, RNRosie Miller, RNJanice Carrozzella, RNJanice Carrozzella, RNKathy Alwell, RNKathy Alwell, RNIrene Ewing, RNIrene Ewing, RNAnn Geers, RNAnn Geers, RNDiane Oberschmidt, RNDiane Oberschmidt, RNColleen Reynolds, RNColleen Reynolds, RNPam Schmit, RNPam Schmit, RNTheo Nodler, RNTheo Nodler, RNDiana Goins, RNDiana Goins, RN

GC/NK Stroke Team MechanicsGC/NK Stroke Team Mechanics

• Single pager number for entire teamSingle pager number for entire team

• Stroke Team members respond to the local hospitalStroke Team members respond to the local hospital

• Stroke Team physician responsible for initial Stroke Team physician responsible for initial treatment decisionstreatment decisions

• Treated patients admitted to local hospital in Treated patients admitted to local hospital in conjunction with primary care physicianconjunction with primary care physician

• Patient care assumed by PCP after first 24 hoursPatient care assumed by PCP after first 24 hours

GC/NK Communication ToolsGC/NK Communication Tools

Call 844-7686TIME IS BRAIN

ACUTE STROKE TEAM CONTACTS

Joseph Broderick, MDOffice: 558-2957Pager: 691-0764Cell: 919-5404Home: 891-3532

Daniel Kanter, MDOffice: 558-5043Pager: 249-8738Cell: 919-5403Home: 792-0051

Art Pancioli, MD (Emer Med)Office: 558-8103Pager: 577-0994Cell: 604-4436Home: 754-1064

Tom Tomsick, MD (Neurorad)Office: 584-0607Pager: 269-4478Cell: 520-0139Home: 561-2115

Janice Carrozzella, RNOffice: 558-4789Pager: 589-5502Cell: 604-3561Home: 352-0847

Brett Kissela, MDOffice: 558-5445Pager: 249-7168Cell: 678-8180Home: 793-6553

Andy Ringer, MD (NeuroSurg)Office: 558-1290Pager/Cell: 256-7444Admin Asst: 475-8662 (Karen)

Daniel Woo, MDOffice: 558-2705Pager: 249-3112Cell: 509 2214Home: 794-1822

Mary Gaskill-Shipley, MD(Neurorad)Office: 584-0605Pager: 269-4354Cell: none

Dawn Kleindorfer, MDOffice: 558-5328Pager: 691-1002Cell: 919-5407Home: 793-4362

Alex Schneider, MDOffice: 558-1480Pager: 554-5315Cell: 859-322-1742Home: 731-0360

Mario Zuccarello, MD (Neurosurg)Office: 558-5387Pager: 269-2344Cell:Admin Asst: 475-8624 (Janine)

Ed Jauch, MD (Emer Med)Office: 558-0474Pager: 590-3191Cell: 604-4434Home: 936-9332

Pete Panagos, MD (Emer Med)Office: 558-0106Pager: 230-9465Cell: 503-3743Home: 871-9047

Judy Spilker, RN (Emer Med)Office: 558-5430Pager: 249-0517Cell: 604-4438Home: 385-6652

 

GC/NK TenetsGC/NK Tenets

• Follow the 3 A’sFollow the 3 A’sAffableAffable

AvailableAvailable

AbleAble

• Provide feedback to Provide feedback to entire “Chain”entire “Chain”

Regional Hospital ResponsibilitiesRegional Hospital Responsibilities• HospitalHospital

– Maintain “Chain of Recovery”, pathwaysMaintain “Chain of Recovery”, pathways

• Emergency NursingEmergency Nursing– Identification of stroke symptoms Identification of stroke symptoms

– Emergent triageEmergent triage

– Assess patient, coordinate care, administer drugsAssess patient, coordinate care, administer drugs

• Emergency PhysiciansEmergency Physicians– Assess and verify onset timeAssess and verify onset time

– Initial medical managementInitial medical management

– Contact Stroke Team earlyContact Stroke Team early

Additional GC/NK RolesAdditional GC/NK Roles

• Education:Education:– Public and EMS stroke educationPublic and EMS stroke education– Community physician educationCommunity physician education

• Patient Care:Patient Care:– Care pathways and protocols for hospitalsCare pathways and protocols for hospitals– National promotion of improved stroke careNational promotion of improved stroke care

• Research:Research:– Clinical trialsClinical trials– EpidemiologyEpidemiology– Basic scienceBasic science

Benefits of GC/NK SystemBenefits of GC/NK System

• Clinical Clinical – The patient gets expertise in stroke care and The patient gets expertise in stroke care and

exposure to latest stroke therapiesexposure to latest stroke therapies

– The local E.D. physician gets helpThe local E.D. physician gets help

– The local hospital gets to keep the patient, unless The local hospital gets to keep the patient, unless they cannot provide necessary servicethey cannot provide necessary service

– Local neurologists get a consult without taking call Local neurologists get a consult without taking call in the middle of the nightin the middle of the night

Benefits of GC/NK SystemBenefits of GC/NK System

• ResearchResearch– Patient population of 1.5 million peoplePatient population of 1.5 million people– Multiple sites for multiple projectsMultiple sites for multiple projects– Representative population for epidemiologic Representative population for epidemiologic

researchresearch– Integrated system for both ischemic and Integrated system for both ischemic and

hemorrhagic strokehemorrhagic stroke

• TrainingTraining– Large system allows for excellent fellow trainingLarge system allows for excellent fellow training

Limitations of GC/NK SystemLimitations of GC/NK System

• ClinicalClinical– Variability in post-stroke treatmentVariability in post-stroke treatment

– Labor intensive and not supported by reimbursementLabor intensive and not supported by reimbursement

– Unique due to competition in health care systemsUnique due to competition in health care systems

– Removes community physicians (emergency medicine Removes community physicians (emergency medicine and neurology) and residents from initial treatment and neurology) and residents from initial treatment processprocess

Limitations of GC/NK SystemLimitations of GC/NK System

• ResearchResearch– In-servicing multiple sitesIn-servicing multiple sites– Duplication of paperwork Duplication of paperwork

(IRB, informed consents, pharmacy, etc)(IRB, informed consents, pharmacy, etc)– Need for larger amounts of study drug or additional Need for larger amounts of study drug or additional

medical devicesmedical devices– Transportation of clinical specimensTransportation of clinical specimens

““When the end of the world When the end of the world comes, comes,

I want to be in Cincinnati I want to be in Cincinnati because it's always twenty yearsbecause it's always twenty years

behind the times."behind the times."