Hospitalists Are Key to Rapid Response to In-Hospital Stroke

Question: What’s the role for the neurohospitalist in the in-hospital response to stroke?

Dr. Cumbler: For hospitals that are lucky enough to have a neurohospitalist program, and ours is one, they are absolutely integral. In our hospital, the neurohospitalists lead the stroke program and form the backbone of the acute stroke response both in the ED and in the inpatient setting. Most hospitals, however, do not have dedicated neurohospitalists, much less an inpatient presence 24-7

Question: How important is the multidisciplinary team when you’re responding to a stroke in the hospital?

Dr. Cumbler: It is critical. All the cylinders have to be firing for an in-hospital stroke to be evaluated and treated within an hour. This team includes hospitalists, neurologists, radiologists, but also nursing, lab technicians, CT technicians, and pharmacists. It’s amazing to think about how many people have to touch the patient having a stroke in order for a patient to go all the way from recognition of new symptoms up on the wards to treatment with thrombolysis. At a minimum, in our institution, it’s eight different people from six different departments. And it may be significantly more, depending on where that patient is and what that patient needs.

So how do you get eight individuals from six different departments to coordinate in under 60 minutes? If you don’t have an interdisciplinary team mechanism, this is going to be extraordinarily difficult. For us, the key to coordinating that was involving the people that needed to be a part of the process from the beginning, which included making pharmacy and CT technicians part of the stroke alert that was sent out as soon as the patient was recognized to have deficits. We then used checklist process cards to keep all of the different members of the team on the same page.

—Mary Ellen Schneider

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to m.schneider@elsevier.com. Read previous columns at ehospitalistnews.com