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Leading Your Stroke Team February 7, 2009
 

Leading Your Stroke Team February 7, 2009

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    Leading Your Stroke Team February 7, 2009 Leading Your Stroke Team February 7, 2009 Presentation Transcript

    • Leading Your Stroke Team February 7, 2009 John R. Belden, MD Medical Director, Stroke Program Neuroscience Institute, Maine Medical Center Financial Disclosures: none
    • Overview
      • How MMC built its’ Stroke Team
      • Concept of a “hospital neurologist”
      • How 30 years of practicing medicine maybe prepared me to do this job
      • What I do
      • What the future holds
      • Accomplishments and Challenges
      • Conclusions
    • MMC Stroke Objectives
      • Provide evidenced based care in a Center of Excellence for Stroke
        • More efficient organization of stroke care, from the ED to discharge
      • Achieve JCAHO “Primary Stroke Center” certification
    • Role of Evidence- Based Medicine
      • Acute stroke
        • Thrombolysis
        • BP
        • DVT
      • Secondary prevention
        • BP
        • Anti-platelet drugs
        • Warfarin
      • Application to Joint Commission standards
    • Necessary Ingredients (2004-2006)
      • Multidisciplinary Stroke Operations Team
      • Clinical Guidelines and Pathways
      • Balanced Scorecard
      • Tools to support evidence-based care
      • (i.e. Order Sets)
      • Standard Data Collection Tool:
      • AHA/ASA “Get With The Guidelines”
      • Co-horting of stroke patients
      • Dedicated Staff
    • Stroke Program Team
      • Core Stroke Team:
      • .2 Medical Director (now .3)
      • .5 Nurse Practitioner
      • .5 Program Manager
      • .5 Data Analyst
      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!
    • Accomplishments
    • Opportunities for Clinical Integration of Stroke Care at System Level
      • Transfer and referral issues
      • Telestroke
      • Consistent care pathways across system
      • Community outreach
    • 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
      • Dysphagia screening
      • Lipid screening
      • Patient education
      • Use of common orders sets
      • Transfer of patients to MMC when “the inn is full” (new beds April 09!)
    • Lessons Learned
          • Vision
          • Leadership
          • Team Work
          • Homework
          • Patience
          • Persistence
          • Assistance
    • Questions and Answers