Leading Your Stroke Team   February 7, 2009   John R. Belden, MD Medical Director, Stroke Program Neuroscience Institute, ...
Overview <ul><li>How MMC built its’ Stroke Team </li></ul><ul><li>Concept of a “hospital neurologist” </li></ul><ul><li>Ho...
MMC Stroke Objectives <ul><li>Provide evidenced based care in a Center of Excellence for Stroke </li></ul><ul><ul><li>More...
Role of Evidence- Based Medicine <ul><li>Acute stroke </li></ul><ul><ul><li>Thrombolysis </li></ul></ul><ul><ul><li>BP </l...
Necessary Ingredients (2004-2006) <ul><li>Multidisciplinary Stroke Operations Team  </li></ul><ul><li>Clinical Guidelines ...
Stroke Program Team <ul><li>Core Stroke Team: </li></ul><ul><li>.2 Medical Director (now .3) </li></ul><ul><li>.5 Nurse Pr...
2007: Incorporated into Neuroscience Institute BRAIN INJURY PEDIATRICS MEMORY DISORDERS NEURO ONCOLOGY EPILEPSY DEGENERATI...
How is it Working? <ul><li>Efficient tracking of quality measures </li></ul><ul><li>Investigate and track mortality, LOS, ...
Accomplishments
Opportunities for Clinical Integration  of Stroke Care at System Level <ul><li>Transfer and referral issues </li></ul><ul>...
Ingredients for Success <ul><li>Hire people with an interest in stroke </li></ul><ul><li>Financial commitment from the hos...
Concept of a “Hospital Neurologist” <ul><li>Economic and stress factors have led neurologists to focus on outpatient work ...
Medical Director: Ingredients for Success <ul><li>Solid training and experience in stroke care </li></ul><ul><li>Familiari...
What do I do at MMC? <ul><li>Three weekly 2 hour sessions </li></ul><ul><li>Many other meetings, lectures, etc. </li></ul>...
What does the future hold at MMC? <ul><li>Telestroke network development </li></ul><ul><li>More work with MMC Research Ins...
Challenges at MMC <ul><li>Organization of stroke beds </li></ul><ul><li>Dysphagia screening </li></ul><ul><li>Lipid screen...
Lessons Learned <ul><ul><ul><li>Vision </li></ul></ul></ul><ul><ul><ul><li>Leadership </li></ul></ul></ul><ul><ul><ul><li>...
Questions and Answers
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Leading Your Stroke Team February 7, 2009

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Leading Your Stroke Team February 7, 2009

  1. 1. Leading Your Stroke Team February 7, 2009 John R. Belden, MD Medical Director, Stroke Program Neuroscience Institute, Maine Medical Center Financial Disclosures: none
  2. 2. Overview <ul><li>How MMC built its’ Stroke Team </li></ul><ul><li>Concept of a “hospital neurologist” </li></ul><ul><li>How 30 years of practicing medicine maybe prepared me to do this job </li></ul><ul><li>What I do </li></ul><ul><li>What the future holds </li></ul><ul><li>Accomplishments and Challenges </li></ul><ul><li>Conclusions </li></ul>
  3. 3. MMC Stroke Objectives <ul><li>Provide evidenced based care in a Center of Excellence for Stroke </li></ul><ul><ul><li>More efficient organization of stroke care, from the ED to discharge </li></ul></ul><ul><li>Achieve JCAHO “Primary Stroke Center” certification </li></ul>
  4. 4. Role of Evidence- Based Medicine <ul><li>Acute stroke </li></ul><ul><ul><li>Thrombolysis </li></ul></ul><ul><ul><li>BP </li></ul></ul><ul><ul><li>DVT </li></ul></ul><ul><li>Secondary prevention </li></ul><ul><ul><li>BP </li></ul></ul><ul><ul><li>Anti-platelet drugs </li></ul></ul><ul><ul><li>Warfarin </li></ul></ul><ul><li>Application to Joint Commission standards </li></ul>
  5. 5. Necessary Ingredients (2004-2006) <ul><li>Multidisciplinary Stroke Operations Team </li></ul><ul><li>Clinical Guidelines and Pathways </li></ul><ul><li>Balanced Scorecard </li></ul><ul><li>Tools to support evidence-based care </li></ul><ul><li>(i.e. Order Sets) </li></ul><ul><li>Standard Data Collection Tool: </li></ul><ul><li>AHA/ASA “Get With The Guidelines” </li></ul><ul><li>Co-horting of stroke patients </li></ul><ul><li>Dedicated Staff </li></ul>
  6. 6. Stroke Program Team <ul><li>Core Stroke Team: </li></ul><ul><li>.2 Medical Director (now .3) </li></ul><ul><li>.5 Nurse Practitioner </li></ul><ul><li>.5 Program Manager </li></ul><ul><li>.5 Data Analyst </li></ul>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
  7. 7. 2007: Incorporated into Neuroscience Institute BRAIN INJURY PEDIATRICS MEMORY DISORDERS NEURO ONCOLOGY EPILEPSY DEGENERATIVE NERVOUS SYSTEM DISORDERS SPINE STROKE NEUROTRAUMA
  8. 8. How is it Working? <ul><li>Efficient tracking of quality measures </li></ul><ul><li>Investigate and track mortality, LOS, “outliers” to optimize care </li></ul><ul><li>Staff, resident, and attending physician medical education- this is a big job! </li></ul><ul><li>Improved “flow” with New England Rehab Hospital </li></ul><ul><li>Research- tough to find time to do this! </li></ul>
  9. 9. Accomplishments
  10. 10. Opportunities for Clinical Integration of Stroke Care at System Level <ul><li>Transfer and referral issues </li></ul><ul><li>Telestroke </li></ul><ul><li>Consistent care pathways across system </li></ul><ul><li>Community outreach </li></ul>
  11. 11. Ingredients for Success <ul><li>Hire people with an interest in stroke </li></ul><ul><li>Financial commitment from the hospital </li></ul><ul><li>Set realistic goals, which can evolve, and keep working at it </li></ul><ul><ul><li>99% perspiration, 1% inspiration </li></ul></ul><ul><li>Monthly meetings to discuss data and old/new ideas </li></ul><ul><li>Organizational structure- “all politics is local” </li></ul><ul><li>Small hospitals- you do not need a neurologist </li></ul>
  12. 12. Concept of a “Hospital Neurologist” <ul><li>Economic and stress factors have led neurologists to focus on outpatient work and resign from hospital medical staffs </li></ul><ul><li>Creation of “neurohospitalist” role to focus on inpatient care </li></ul><ul><li>MMC coverage provided by Maine Neurology and one private physician </li></ul><ul><li>Call coverage rotated job in 3 to 4 day shifts; consultative work only </li></ul><ul><li>Continuing education on a wide range of neurological disorders affecting sick hospitalized patients provided </li></ul>
  13. 13. Medical Director: Ingredients for Success <ul><li>Solid training and experience in stroke care </li></ul><ul><li>Familiarity with primary care doctors and pertinent specialists in the region </li></ul><ul><li>Business skills not really needed, but handy </li></ul><ul><li>“ Collaborative” personality </li></ul>
  14. 14. What do I do at MMC? <ul><li>Three weekly 2 hour sessions </li></ul><ul><li>Many other meetings, lectures, etc. </li></ul><ul><li>2-3 hrs. per week on e-mail </li></ul><ul><li>Many hours a week of lecture preparation, writing guidelines, etc. </li></ul><ul><li>Evolving “Telestroke Program” </li></ul><ul><li>Small amount of research </li></ul>
  15. 15. What does the future hold at MMC? <ul><li>Telestroke network development </li></ul><ul><li>More work with MMC Research Institute </li></ul><ul><li>Selected clinical trials </li></ul><ul><li>Transition to medical school relationship with Tufts </li></ul>
  16. 16. Challenges at MMC <ul><li>Organization of stroke beds </li></ul><ul><li>Dysphagia screening </li></ul><ul><li>Lipid screening </li></ul><ul><li>Patient education </li></ul><ul><li>Use of common orders sets </li></ul><ul><li>Transfer of patients to MMC when “the inn is full” (new beds April 09!) </li></ul>
  17. 17. Lessons Learned <ul><ul><ul><li>Vision </li></ul></ul></ul><ul><ul><ul><li>Leadership </li></ul></ul></ul><ul><ul><ul><li>Team Work </li></ul></ul></ul><ul><ul><ul><li>Homework </li></ul></ul></ul><ul><ul><ul><li>Patience </li></ul></ul></ul><ul><ul><ul><li>Persistence </li></ul></ul></ul><ul><ul><ul><li>Assistance </li></ul></ul></ul>
  18. 18. Questions and Answers

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