Neuro: Wasting No Time

Joe Cantlupe, for HealthLeaders Media , November 13, 2012
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Some hospitals working to achieve those "speed" goals are also wasting no time in developing comprehensive, coordinated stroke programs. Some aren't stopping at building stroke centers and are rounding out a vision for more comprehensive neurological centers, which many hospital leaders say eventually will be accredited by groups such as the Joint Commission.

"We have seen neurosciences as an up-and-coming service line," says Mona Euler, RN, vice president of neuroscience at the 3,326-bed Indiana University Health, based in Indianapolis. "It's relatively new compared to other service lines, but it is being driven by the need of patients. Millions of Americans are suffering at some point from neurological disease and need treatment. The neuroscience service line is just an excellent area for most hospitals to get into."

Euler says Indiana University Health has developed a "one-stop shop" for neuroscience care for various neurological system disorders. The system's health neuroscience center is combining resources with the Indiana University School of Medicine for multiple neuroscience specialties.

By having a coordinated approach, Indiana University Health has been certified as a primary care stroke center, a recognition of making an exceptional effort to foster better outcomes for stroke care. Demonstrating compliance with the Joint Commission's national standards and performance measurement expectations may help obtain contracts with purchasers and help control costs and improve productivity, the commission states. The Joint Commission's Primary Stroke Center Certification program was developed in collaboration with the American Stroke Association.

"We want to offer the most comprehensive care in neuroscience," Euler says. "It was a vision of our senior leaders. We wanted to unite research, education, and clinical all in one. We felt we were fragmented by being in different locations before."

Success key No.1: Coordination

By implementing a coordination of care program, the 86-staffed-bed Saint Luke's Neuroscience Institute has increased its speed in responding to stroke patients sent to the hospital. As a result, the Kansas City, Mo.–based facility has been able to use a significant medical therapy for stroke patients more often than other hospitals have.

Saint Luke's Neuroscience Institute has specialized in tissue plasminogen activator (tPA), the only FDA-approved therapy for acute ischemic stroke.

Despite being widely available since 1996, the therapy is still significantly underutilized. That can be attributed, in part, to the fact that tPA must be used on patients within three hours of a stroke's onset. In 2009, tPA treatment rates nationwide were only up to 5.2%, about twice the rate from 2005, according to Marilyn Rymer, MD, medical director and director of research at Saint Luke's Neuroscience Institute.

Saint Luke's uses the treatment at a rate twice the national average, says Rymer. Its initiatives have resulted in greater access to treatment, showing an increase of 23% in volume from 2005 to 2010. Overall, the total number of stroke patients treated at Saint Luke's increased 19.6%, from 567 to 678 from 2010 to 2011. The tPA treatment increased from 136 to 177, a 30% increase from 2010 to 2011, she adds.

"The first barrier is getting people to the right facility in time for treatment, with the IV tPA time window of three to four-and-one-half hours for treatment," Rymer says. "The next barrier is that many hospitals do not have acute stroke teams to attend to the patients very quickly. The CT scan is essential before treatment, and some hospitals do not have 24-hour access."

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