Approximately 795,000 strokes occur each year in the United States; Stroke is a leading cause of death nationally and remains the leading cause of longterm disability. Only ten percent of the hospitals in the US have Stroke Centers certified by the Joint Commission. A critical barrier to stroke care is the shortage of neurologists or neurohospitalists. Stroke telemedicine is a consultative modality that facilitates care of patients with acute stroke at underserved hospitals by remotely based stroke. Stroke Center guidelines prefer a neurologist as Medical Director but hospitalists are an acceptable alternative. A literature review found no outcome data comparing hospitalists to neurologists as Stroke Center Medical Directors.
Describes the roles and function of hospitalist as a medical director of stroke center and evaluate results of telemedicine on stroke center.
Medical director of stroke center roles include administrative/adherence to nationally established guidelines for stroke care by joint commission, conducting ongoing review and analysis of quality of care of performance data and providing stroke education for healthcare providers (Fig. 1). Telemedicine gives patients and physicians immediate access to stroke specialists. With time to treatment being such a critical factor in determining how well a patient recovers from a stroke, telemedicine consultation plays a significant role in saving lives and improving patient outcomes. Approximately 240 patients were admitted to the Stroke Center at South Fulton Medical center for the first year after implementation; 10 patients received tPA; 98% of strokes were nonhemorrhagic strokes. The number of stroke cases increased by over more than 75% compared to the year prior to the launch of the stroke program.
A Hospitalist with operational experience can serve as Medical Director to drive process and system improvements to the Stroke Center (table 1). In its first year of operation, a hospitalisttelemedicine supported stroke center that screens out ICH cases in the ED reported patient evidence based outcomes including timely thrombolytic therapy and mortality comparable with other Joint Commission certified Stroke Centers. The integrated hospitalist telestroke program at South Fulton Medical Center earned the Joint Commission’s certification as an Advanced Primary Stroke Center and received American Stroke Association’s GoldPlus status.
Table 1Additional Roles for a medical Director of a Telemedicine Supported Stroke Center
|ADMINISTRATIVE||1) Report to Stroke Task force/Committee for all stroke related telemedicine activites 2) Develop Policies and procedures to optimize use of hospital based telemedicine 3) Develop communication strategies for telemedicine based stroke initiatives 4) Review telemedicine based services for quality of patient care 5) Liaison with Dept. of information technology to maintain telemedicine infrastructure 6) Coordinate care practices between teleneurologist and medical staff 7) Onsite representative to hospital for teleneurologist|
|QUALITY||1) Ensure that care is consistent with current stroke and telemedicine based care practices 2) Implement structured tools to monitor teleneurologist utilization, practices and performance 3) Develop strategies to decrease identified telemedicinerelated complications 4) Monitor teleneurologist for compliance with hospital bylaws and other regulatory requirements 5) Help support the maintenance of telemedicine based devices|
|EDUCATION||1) Provide telemedicine in services programs for hospital nursing and ancillary personnel 2) Develop telemedicine education programs for the hospital’s medical staff 3) Maintain knowledge of best practices and new advances in telemedicine based stroke center|
To cite this abstract:Ventura J, Godamunne K. Hospitalist As Medical Director of a Telemedicine Supported Stroke Center: Identifying Key Roles for Success. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97750. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/hospitalist-as-medical-director-of-a-telemedicine-supported-stroke-center-identifying-key-roles-for-success/. Accessed September 18, 2019.