Acute Myocardial Infarction

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Creating and Sustaining the Greater Cincinnati /
Northern Kentucky Stroke Team
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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)
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Greater Cincinnati / Northern Kentucky Stroke
TeamA Community Resource
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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

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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

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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

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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

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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

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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

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GC/NK Communication Tools
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GC/NK Tenets

• Follow the 3 As
• Affable
• Available
• Able
• Provide feedback to entire Chain

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Regional Hospital Responsibilities

• Hospital
• 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

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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

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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

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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

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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

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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

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• When the end of the world comes,
• I want to be in Cincinnati
• because it's always twenty years
• behind the times."