William Jones, MD, has seen significant advancements in the treatment of stroke during his career in neurology. Now he’s on the forefront of an advancement that could change how stroke care is delivered.
Dr. Jones leads a team at University of Colorado Hospital (UCH) studying the impact and efficacy of a mobile stroke unit—a modified ambulance dispatched by 911 to assess patients experiencing symptoms of stroke en route to the hospital.
The unit is equipped with telehealth technology and a portable CT scanner. “But more importantly, it includes a specially trained crew, which typically includes an EMT, paramedic, CT technologist and an ICU-level trained nurse,” said Dr. Jones.
According to Steven Ringel, MD, vice chair of the Department of Neurology, Dr. Jones’ leadership has been essential to improving stroke care at UCH. “Dr. Jones has been at the forefront of developing strategies to reduce the time between diagnosis and administration of intravenous and/or intra-arterial thrombolytic agents in treating an acute stroke,” said Dr. Ringel. “His easygoing manner fostered cooperation with other departments and the end result has been better care for stroke patients.”
When Dr. Jones was a resident, treatment of stroke was fairly limited, with providers focusing on stabilizing patients and preventing complications. Everything changed in the mid-1990s when a study in Germany demonstrated a “clot busting” treatment called tissue plasminogen activator (tPA). When administered within a few hours of symptom onset, outcomes greatly improved.
Fast forward to today, when hospital teams worldwide have accepted tPA as the frontline treatment for patients experiencing the onset of ischemic stroke. Most hospitals, including UCH, have created multidisciplinary rapid response teams that include members of the emergency department, radiology, neurology, neurosurgery, internal medicine and pharmacy. Time to treatment for patients presenting to the emergency department has been reduced to 45 minutes.
Yet stroke continues to be the number five cause of death and a leading cause of disability in the U.S. And it’s expensive—in 2010 the direct and indirect costs of stroke treatment were estimated at $70 billion per year.
“Our team believes we should always be pushing forward,” said Dr. Jones. When the team learned about a mobile stroke unit implemented by a German researcher, their interest piqued. Within a few years, they began partnering with researchers at a variety of institutions, including the University of Texas Health Science Center at Houston, as part of a nationwide study of mobile stroke units.
The UCH mobile stroke unit launched in Aurora in January 2016, and has been spending alternate weeks in Colorado Springs since July.
During the hours of 8 a.m. to 8 p.m., the stroke unit is mobilized whenever UCH receives notification that a 911 dispatcher has received a call from a patient they believe might be experiencing a stroke. The stroke team typically arrives within a few minutes of the EMS response team, and together they assess the patient and transfer to the stroke unit as appropriate. If indicated, tPA treatment begins in the mobile unit prior to reaching the emergency department.
Although outcomes data at this point are anecdotal, Dr. Jones believes they are reducing time to treatment by a minimum of 15 minutes. And considering “time is brain,” serious cases may benefit the most from quicker treatment. Dr. Jones describes a recent case of a 39-year-old woman with two young children. “The initial evaluation indicated she was experiencing a severe, possibly devastating stroke,” he said. “We started treatment in the mobile unit. Three days later, the patient left the hospital with minimal symptoms.”
Now that the mobile stroke unit is operating and the team has honed its processes, Dr. Jones and researchers from around the country are beginning the research phase of the project.
“These units are expensive to build and to operate, and there’s no way to get significant reimbursement at this point,” Dr. Jones said. “There are a lot of challenges, but we really believe it will improve outcomes. But we need to prove that it’s benefitting patients and it’s cost effective.”
Dr. Jones says they will also be analyzing the appropriate settings for mobile stroke units. “Although both Aurora and Colorado Springs are large urban areas, the advantage to our participation is that we also serve a lot of rural areas,” he explained. “This will help us determine how a mobile unit might work in smaller cities and rural settings.”
Without the significant efforts of a multidisciplinary team, Dr. Jones believes this project would never have gotten off the ground. “It’s really important to recognize that this was an effort from multiple people as well as members of the community, including the mayor of Aurora,” he said. He also notes that above all, the efforts of the well-trained crew should be commended.
“They are enthusiastic, and they love what they are doing, too.”
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