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 MedicineOriginated 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.”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 Team A Community Resource =

4. GC/NK Hospital Network Research NetworkResearch Network 15 Hospitals 1 University1 University 3 Teaching3 Teaching 11 Community11 Community Also provides acute stroke phone consultation and referral for 20 regional hospitalsAlso provides acute stroke phone consultation and referral for 20 regional hospitals

5. GC/NK Stroke Team Elements Acute treatment physiciansAcute treatment physicians Nurse coordinatorsNurse coordinators Neurosurgeons and neuroradiologistsNeurosurgeons and neuroradiologists Clinical fellows in neurology and emergency medicineClinical fellows in neurology and emergency medicine Biostatistics / Grant support staffBiostatistics / Grant support staff Basic science researchersBasic science researchers EMS personnelEMS personnel

6. GC/NK Stroke Team Personnel Roles PhysiciansPhysicians –Provide acute stroke care –Develop clinical research –Interface with hospital medical staff Nurse coordinatorsNurse 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 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

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 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 treatment decisionsStroke Team physician responsible for initial treatment decisions Treated patients admitted to local hospital in conjunction with primary care physicianTreated patients admitted to local hospital in conjunction with primary care physician Patient care assumed by PCP after first 24 hoursPatient care assumed by PCP after first 24 hours

10. GC/NK Tenets Follow the 3 A’sFollow the 3 A’sAffableAvailableAble Provide feedback to entire “Chain”Provide feedback to entire “Chain”

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

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

13. Benefits of GC/NK System ClinicalClinical –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 ResearchResearch –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 TrainingTraining –Large system allows for excellent fellow training

15. Limitations of GC/NK System ClinicalClinical –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 ResearchResearch –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." behind the times."