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Survey Finds Increasing Popularity of Acute Stroke Teams in U.S. Hospitals

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Duke Health News 919-660-1306

ORLANDO, FL – In the past, the brain and heart have received
different treatment, at least when it comes to emergencies.
When "code blue" teams rush to someone having a heart attack,
their goal is to jump-start the heart to re-establish blood
flow to the brain. Such teams have been hospital staples for
years; however, the emergence of similar teams to help patients
suffering from an equally deadly problem – stroke – is only an
emerging phenomenon.

It is also a trend that should have started years earlier,
according to a Duke University Medical Center neurologist.

"It only makes sense for a team to respond just as quickly
to a brain attack as a heart attack – the goal in both is to
begin treatment as soon as possible to minimize the damage to
the brain," said Dr. Mark Alberts, who in 1995 called for the
creation of acute stroke teams (AST) in a paper in the Annals
of Internal Medicine.

ASTs are staffed by specially trained physicians and/or
nurses who respond immediately to cases of suspected stroke,
whether occurring in patients already in the hospital or newly
arrived in the emergency room. More than 500,000 Americans will
suffer a stroke each year. Of those, approximately 150,000 will
die, making stroke the third leading cause of death and the
leading cause of disability.

With the usage of new clot-busting drugs, which, when given
within the first three hours of the onset of stroke can reduce
and in some cases eliminate the negative impact of stroke, it
is crucial to have well-trained teams that can respond quickly
to stroke patients.

To determine how the concept has been received in the
medical community, Alberts and his colleagues in the National
Acute Stroke Team Group conducted a nationwide survey, the
results of which were prepared for presentation Thursday (Feb.
5) at the American Heart Association's 23rd International Joint
Conference on Cerebral Circulation and Stroke.

Detailed surveys were mailed to 60 directors of major stroke
programs and neurovascular experts in the United States; 45
were completed and returned. The results included:

Ninety-one percent of respondents had ASTs, with two-thirds
of them being formed recently – between 1995 and 1997.

Sixty-four percent of AST programs cost less than $10,000
per year to operate; 59 percent cost less than $5,000
annually.

In almost all programs, teams were lead by attending
neurologists and/or neurosurgeons.

In 39 percent of cases, the teams received 2-3 calls per
week; 29 percent of teams received more than five calls per
week.

AST staffing consisted of attending physicians (95 percent),
nurses or study coordinators (73 percent), fellows (49 percent)
and residents (48 percent).

The large majority, 78 percent, were able to respond to
calls within 10 minutes.

"We are very encouraged by the growth in the number of acute
stroke teams," Alberts said. "However, the majority of teams
tends to be in the nation's academic health centers. Since the
majority of stroke patients usually come to community or rural
hospitals first, one of our goals is to get the word out that
they can benefit from having these teams."

One finding of the survey, which should appeal to smaller
hospitals, is the cost, according to Alberts.

"With most programs costing less than $10,000 per year, it
should not place a great financial burden on hospitals,"
Alberts said. "And while we don't have concrete data on the
outcomes of patients treated by ASTs, those of us who treat
them strongly suspect that patients are benefitting."

While the teams appear to be economical to operate in
financial terms, the main commitment by a hospital is the time
of its health care staff, Alberts said. Staffing patterns, as
illustrated by the survey, should help administrators of
community and rural hospitals decide to establish ASTs.

"Officials at many smaller hospitals feel that these teams
are staffed primarily by residents and fellows, which are found
primarily at academic health centers," Alberts said. "However,
the survey showed that almost every team was led by an
attending physician. Attending physicians in these hospitals
are accustomed to being 'on-call.' Participating in an acute
stroke team would be no different. A minority of ASTs are
staffed by residents and fellows.

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