New Models for Hospital‐Based Stroke Care: Leveraging Hospitalists and Telemedicine to Build a Joint Commission Certified Primary Stroke Center

Background:

Stroke is a leading cause of mortality and morbidity. Only 10% of the hospitals in the United States have stroke centers certified by the Joint Commission. Many other hospitals lack the ability to give thrombolytics (tPA). A major barrier is the shortage of stroke specialists. This study reports on the first‐year experience with the Joint Commission Certified (JC) Stroke Center at South Fulton Medical Center (SFMC), East Point, Georgia. The Stroke Center at SFMC addressed the shortage of neurologists by combining a 24/7 telemedicine‐based stroke consult service with a hospitalist team and a hospitalist serving as the Stroke Medical Director. At SFMC there is limited part‐time in‐house neurology coverage (coverage varying from weekdays only to 2 days a week in‐house coverage). By combining telemedicine, hospitalists, and neurologists, the number of hospitals that can build stroke centers may be increased, improving patient access to the stroke standard of care.

SFMC PSC core measures.

Methods:

For this retrospective cohort study, the records for stroke patients from the Primary Stroke Center (PSC) at SFMC were reviewed from October 15, 2009, through October 14, 2010, for the PSC core measures, length of stay (LOS), type of stroke, in‐house mortality, and demographics. Data were collected on the number of stroke discharges from SFMC for the prior 2‐year periods, for percentage of stroke patients admitted by hospitalists, and total number of admits to the SFMC Stroke Center. The PSC core measures, LOS, and mortality from SFMC were compared with the aggregate of all other JC stroke centers over the period of the study. Statistical analysis was performed using the chi‐square and unpaired t tests dependent on variables. PSC core measures were deep vein thrombosis prophylaxis by end of day 2 of admission, antithrombotic therapy at discharge for ischemic strokes, anticoagulation therapy form ischemic stroke patients at discharge, tPA for patients with ischemic stroke within 3 hours of last‐known well, antithrombotic therapy for ischemic stroke by end of day 2 of admission, statin medicine for LDL ≥ 100 for ischemic stroke patients, stroke education for patients and caregivers, and assessment of stroke patients for rehabilitation.

Results:

About 250 patients were admitted to the SFMC Stroke Center. One hundred and sixty‐four patients were discharged with a stroke diagnosis. Eleven patients received tPA; no stroke patients prior to launch of the stroke center received tPA. The number of stroke admits to SFMC increased by 90% compared with prior years. The PSC measures, mortality, and LOS from SFMC were not statistically different than that at other stroke centers. Seventy percent of stroke admits were by hospitalists. Ninety‐eight percent were nonhemorrhagic strokes.

Conclusions:

This study supports that a primary stroke center can be built with a telemedicine/hospitalist/neurologist model. This includes the immediate benefit of thrombolytics and the secondary preventive benefits of meeting stroke center guidelines. Mechanisms must address hemorrhagic strokes that require neurosurgical intervention.

Disclosures:

K. Godamunne ‐ Eagle Hospital Physicians, employee