1. Creating and Sustaining the
Greater Cincinnati / Northern Kentucky Stroke Team
Edward C. Jauch, MD MS FACEP
Assistant Professor
Department of Emergency Medicine
and
Faculty, 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 Team A Community Resource=
From the very beginning it was designed not to be solely a University based system, rather involve all Tri-state hospitals as a regional 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
Because the team was also founded founded to facilitate research and training, members of the team not only include the expected acute treatment elements but also key personnel who support the research efforts.

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
MD –
Local MD staff includes discussions with PMD in individual cases, establishing practice guidelines (TNI), CME programs, etc
RN –
Infrastructure includes local stroke pathways and study materials/drug at each hospital.
Local RN’s often hired for research, facilitating investment by hospital into system and developing local champion.

7. GC/NK Stroke Team Physicians
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
Interventional Neuroradiology
Tom Tomsick, MD
Mary Gaskill-Shipley, MD
Neurosurgery
Mario Zuccarello, MD
Andrew Ringer, MD
Current Fellows
Peter Panagos, MD
Additional interventional neuroradiology also available at two other hospitals to provide backup

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
Redundancy in the system
Backup available and helpful in training setting with decentralized system

10. GC/NK Communication Tools
Call
TIME IS BRAIN
ACUTE STROKE TEAM CONTACTS
Joseph Broderick, MD
Office:
Pager:
Cell:
Home:
Daniel Kanter, MD
Office:
Pager:
Cell:
Home:
Art Pancioli, MD (Emer Med)
Office:
Pager:
Cell:
Home:
Tom Tomsick, MD (Neurorad)
Office:
Pager:
Cell:
Home:
Janice Carrozzella, RN
Office:
Pager:
Cell:
Home:
Brett Kissela, MD
Office:
Pager:
Cell:
Home:
Andy Ringer, MD (NeuroSurg)
Office:
Pager/Cell:
Admin Asst: (Karen)
Daniel Woo, MD
Office:
Pager:
Cell:
Home:
Mary Gaskill-Shipley, MD
(Neurorad)
Office:
Pager:
Cell: none
Dawn Kleindorfer, MD
Office:
Pager:
Cell:
Home:
Alex Schneider, MD
Office:
Pager:
Cell:
Home:
Mario Zuccarello, MD (Neurosurg)
Office:
Pager:
Cell:
Admin Asst: (Janine)
Ed Jauch, MD (Emer Med)
Office:
Pager:
Cell:
Home:
Pete Panagos, MD (Emer Med)
Office:
Pager:
Cell:
Home:
Judy Spilker, RN (Emer Med)
Office:
Pager:
Cell:
Home:
Similar for RN’s and interventional neuroradiology

11. GC/NK Tenets Follow the 3 A’s Provide feedback to entire “Chain”
Affable
Available
Able
Provide feedback to entire “Chain”
Feedback is through two systems –
Weekly stroke team meetings with entire team and open to all
Letters, calls, CME with regional EMS, ER staff, and PCP

12. Regional Hospital Responsibilities
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
Example of hospital role: tPA not RPA in PIXUS, CT availability, floor care

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
Expanding treatment window confuse hospitals

19. “When the end of the world comes, I want to be in Cincinnati
because it's always twenty years
behind the times."
Functional neurologic deficit influenced as much by location as by infarct size.