Extended Team: Emergency Department Physicians and Nursing, Stroke Unit Nursing Directors, Chief of Medicine, Neurologists, Neuro-radiologists, Physiatry, Rehab and other Clinical Staff and Administration
2007: Incorporated into Neuroscience Institute BRAIN INJURY PEDIATRICS MEMORY DISORDERS NEURO ONCOLOGY EPILEPSY DEGENERATIVE NERVOUS SYSTEM DISORDERS SPINE STROKE NEUROTRAUMA
How is it Working?
Efficient tracking of quality measures
Investigate and track mortality, LOS, “outliers” to optimize care
Staff, resident, and attending physician medical education- this is a big job!
Improved “flow” with New England Rehab Hospital
Research- tough to find time to do this!
Opportunities for Clinical Integration of Stroke Care at System Level
Transfer and referral issues
Consistent care pathways across system
Ingredients for Success
Hire people with an interest in stroke
Financial commitment from the hospital
Set realistic goals, which can evolve, and keep working at it
99% perspiration, 1% inspiration
Monthly meetings to discuss data and old/new ideas
Organizational structure- “all politics is local”
Small hospitals- you do not need a neurologist
Concept of a “Hospital Neurologist”
Economic and stress factors have led neurologists to focus on outpatient work and resign from hospital medical staffs
Creation of “neurohospitalist” role to focus on inpatient care
MMC coverage provided by Maine Neurology and one private physician
Call coverage rotated job in 3 to 4 day shifts; consultative work only
Continuing education on a wide range of neurological disorders affecting sick hospitalized patients provided
Medical Director: Ingredients for Success
Solid training and experience in stroke care
Familiarity with primary care doctors and pertinent specialists in the region
Business skills not really needed, but handy
“ Collaborative” personality
What do I do at MMC?
Three weekly 2 hour sessions
Many other meetings, lectures, etc.
2-3 hrs. per week on e-mail
Many hours a week of lecture preparation, writing guidelines, etc.
Evolving “Telestroke Program”
Small amount of research
What does the future hold at MMC?
Telestroke network development
More work with MMC Research Institute
Selected clinical trials
Transition to medical school relationship with Tufts
Challenges at MMC
Organization of stroke beds
Use of common orders sets
Transfer of patients to MMC when “the inn is full” (new beds April 09!)