- Departments of Neurology and Neurosurgery
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- A Companion to the 8th Edition
- Journal of Neurology | Neurology Neurosurgery | Neurological Research
Right now, we have a HUB and spoke model, consisting of primary stroke centers and comprehensive stroke centers, she notes. At primary centers, patients can receive tPA, whereas comprehensive stroke centers must have the ability to perform endovascular procedures along with other procedures for hemorrhages, aneurysms, etc. Fifi points out that these systems are already in place in many big cities in the US.
Sometimes, however, there is a delay in the process, particularly if patients who are candidates for endovascular therapy are first taken to a primary center. The kind of bypass is being worked out on a regional, city-by-city basis, she explains. So much is based on local politics, she adds. Another significant factor is the impact on population volume and traffic on time to treatment. In New York City, for example, there are several comprehensive stroke centers in Manhattan, and while Queens is geographically close enough that patients from a primary stroke center can be sent to Manhattan, it can be very hard to find a comprehensive stroke center within 30 minutes, Dr.
Fifi observes. Hospital networks can also have an important influence on the treatment process. In New York, Mount Sinai Medical Center is a comprehensive stroke center and is part of a large network of hospitals consisting of several primary centers, she says. Primary stroke centers have a team there that can facilitate diagnosing and getting patient ready for procedure, then we transport ourselves and be ready in procedure room in shorter amount of time, she says.
While this notion might be effective for large hospital networks, it may not translate so easily in all other situations. You can have a stroke interventionalist in almost every city and they would have some amount of cases, but if you put a stroke interventionalist in a small hospital, they may not have enough volume to keep their skills up, Dr. Fifi imparts. No one knows the right answer, but there should be balance somewhere in between where non-urban neurointerventionalists are going to have enough volume to have skills to do the procedure and people have access to procedure.
Despite these challenges, Dr. Fifi believes that the process of ensuring timely care and access to endovascular therapy is moving in the right direction.
Departments of Neurology and Neurosurgery
Right now, smaller hospitals are hiring neurointerventionalists to do procedures and comprehensive stroke centers are developing relationships with other hospitals in creating networks to transfer patients in, she says. According to Dr. Yavagal, the pressure to achieve that balance is incredibly high. For every 30 minute delay, there is a 10 percent chance of the patient not being independent, which is quite high, Dr.
So not only do we need to devise our stroke systems so that everyone has access to them, but that access needs to be very fast, like in the trauma model of care but even more time-sensitive to an extent. As new systems of care take shape, Dr.
Fifi and Dr. Yavagal agree that general neurologists will have an increasingly significant part to play. Implementation is going to take time to be fully realized at all centers, and neurologists will have an important role in directing patients to the right therapy, says Dr.
Watch Dr. Fifi also discusses the practical challenges of navigating care networks and facilitating a team-based approach to allow for optimal outcomes. Fifi, general neurologists will need to help with the rapid triaging of patients. When the patient presents to a local ER, the general neurologist may be called, and they will need to determine if the patient is a candidate for the procedure, and if they should be transferred to a CSC, says Dr.
Therefore, education will be paramount as stroke care delivery networks continue their evolution. If more general neurologists are attuned to the changing guidelines, they can play a critical role in helping patients get the care they need as well as assist in the development of efficient practices and protocols moving forward. For primary stroke centers that are taking care of stroke patients, typically the first test is a CT scan, which rules out bleeding, says Dr.
Then, the common test that was used to actually identify large vessel occlusion was a CT angiogram.
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This may be more or less difficult to get depending on the hospital, according to Dr. Given the variability of access to CT angiograms, Dr. Fifi recommends building a good line of communication with the radiology department. Fifi suggests. Another effective way of ensuring rapid and efficient triaging is to know ahead of time which hospitals can perform the procedures in your community, says Dr. A lot of comprehensive stroke centers or places that have this capability are willing to receive patients and are organizing rapid transport systems, she adds.
Many of these systems are set up ahead of time, so a comprehensive stroke center may have a telemedicine relationship with a hospital in a rural place. Fifi recommends contacting the closest comprehensive center ahead of time, as this may expedite the transfer process. Setting up alliances ahead of time is especially beneficial, she observes. We are at a unique juncture in the realm of stroke care, Dr.
Moreover, the extent of the breakthrough cannot be overstated, according to Dr. Patients no longer have to think about stroke as a life sentence anymore, he says. Though it will undoubtedly take time for the appropriate systems of care to develop, Dr. Yavagal believe that neurologists have a pivotal role to play right now.
Neurologists have a huge incentive to become champions of stroke care, says Dr. The gratification of playing a role in reversing paralysis in a stroke patient is unparalleled for anyone. Jessalyn K. Doctors recommend neurorehabilitation to help people reduce symptoms and improve physical and mental function.
Neurosurgery procedures and tests diagnose, manage, or treat conditions and disorders that affect the nervous system, including the brain, spinal cord, and nerves. They may be invasive surgical , minimally invasive, or noninvasive. The chance of developing a stroke can be reduced by taking steps to prevent and control factors that can put you at greater risk. This FREE stroke risk educational tool provides a personalized, strictly confidential information that will help you:.
Take the Stroke Assessment.
A Companion to the 8th Edition
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Journal of Neurology | Neurology Neurosurgery | Neurological Research
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