Original Article

Availability of Hospital Resources and Specialty Services for Stroke Care in North Carolina

Authors: Mehul D. Patel, PhD, Gilson Honvoh, MSPH, Antonio R. Fernandez, PhD, Rhonda Cadena, MD, Emma R. Kelly, BSPH, Philip McDaniel, MA, Jane H. Brice, MD, MPH

Abstract

Objectives: Effective regionalization of acute stroke care requires assessment and coordination of limited hospital resources. We described the availability of stroke-specific hospital resources (neurology specialty physicians and neuro-intensive care unit [neuro-ICU] bed capacity) for North Carolina overall and by region and population density. We also assessed daily trends in hospital bed availability.

Methods: This statewide descriptive study was conducted with data from the State Medical Asset Resource Tracking Tool (SMARTT), a Web-based system used by North Carolina to track available medical resources within the state. The SMARTT system was queried for stroke-specific physician and bed resources at each North Carolina hospital during a 1-year period (June 2015–May 2016), including daily availability of neuro-ICU beds. We compared hospital resources by geographic region and population density (metropolitan, urban, and rural).

Results: Data from 108 acute care hospitals located in 75 of 100 counties in North Carolina were included in the analysis. Fifty-seven percent of hospitals had no neurology specialty physicians. Western and eastern North Carolina had the lowest prevalence of these physicians. Most hospitals (88%) had general ICUs, whereas only 17 hospitals (16%) had neuro-ICUs. Neuro-ICUs were concentrated in metropolitan areas and in central North Carolina. On average, there were 276 general ICU and 27 neuro-ICU beds available statewide each day. Daily neuro-ICU bed availability was lowest in eastern and southeastern regions and during the week compared with weekends.

Conclusions: In North Carolina, stroke-specific hospital subspecialists and resources are not distributed evenly across the state. Daily bed availability, particularly in neuro-ICUs, is lacking in rural areas and noncentral regions and appears to decrease on weekdays. Regionalization of stroke care needs to consider the geographic distribution and daily variability of hospital resources.
Posted in: Neurology17

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References

1. Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation 2018;137:e67-e492.
2. Voeks JH, McClure LA, Go RC, et al. Regional differences in diabetes as a possible contributor to the geographic disparity in stroke mortality: the REasons for Geographic and Racial Differences in Stroke Study. Stroke 2008;39:1675-1680.
3. Bertoni AG, Ensley D, Goff C. 30,000 fewer heart attacks and strokes in North Carolina. NC Med J 2012;73:449-456.
4. Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015;46:3020-3035.
5. Jauch EC, Saver JL, Adams HP, Jr et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947.
6. Stroke Unit Trialists’ Collaboration. Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke. BMJ 1997;314:1151-1159.
7. Fonarow GC, Reeves MJ, Smith EE, et al. Characteristics, performance measures, and in-hospital outcomes of the first one million stroke and transient ischemic attack admissions in get with the guidelines-stroke. Circ Cardiovasc Qual Outcomes 2010;3:291-302.
8. Goldstein JH, Denslow SA, Goldstein SJ, et al. Intra-arterial therapy for acute stroke and the effect of technological advances on recanalization findings in a community hospital. NC Med J 2016;77:79-86.
9. Gonzales S, Mullen MT, Skolarus L, et al. Progressive rural-urban disparity in acute stroke care. Neurology 2017;88:441-448.
10. Shultis W, Graff R, Chamie C, et al. Striking rural-urban disparities observed in acute stroke care capacity and services in the Pacific northwest: implications and recommendations. Stroke 2010;41:2278-2282.
11. Mullen MT, Wiebe DJ, Bowman A, et al. Disparities in accessibility of certified primary stroke centers. Stroke 2014;45:3381-3388.
12. Desai A, Bekelis K, Zhao W, et al. Association of a higher density of specialist neuroscience providers with fewer deaths from stroke in the United States population. J Neurosurg 2013;118:431-436.
13. Ciliberti-Vargas MA, Gardener H, Wang K, et al. Stroke hospital characteristics in the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities Study. South Med J 2017;110:466-474.
14. Goldstein LB. Statewide hospital-based stroke services in North Carolina: changes over 10 years. Stroke 2010;41:778-783.
15. Fargen KM, Fiorella D, Albuquerque F, et al. Systematic regionalization of stroke care. J Neurointerv Surg 2015;7:229-230.
16. Fargen KM, Jauch E, Khatri P, et al. Needed dialog: regionalization of stroke systems of care along the trauma model. Stroke 2015;46:1719-1726.
17. Asimos AW, Ward S, Brice JH, et al. A geographic information system analysis of the impact of a statewide acute stroke emergency medical services routing protocol on community hospital bypass. J Stroke Cerebrovasc Dis 2014;23:2800-2308.
18. Schlemm E, Ebinger M, Nolte CH, et al. Optimal transport destination for ischemic stroke patients with unknown vessel status: use of prehospital triage scores. Stroke 2017;48:2184-2191.
19. Patel MD, Brice JH, Evenson KR, et al. Emergency medical services capacity for prehospital stroke care in North Carolina. Prev Chronic Dis 2013;10:E149.
20. Southerland AM, Johnston KC, Molina CA, et al. Suspected large vessel occlusion: should emergency medical services transport to the nearest primary stroke center or bypass to a comprehensive stroke center with endovascular capabilities? Stroke 2016;47:1965-1967.
21. Grover JM, Morales CI, Brice JH. EMS and acute stroke care: evidence for policies to reduce delays to definitive treatments. Curr Cardiovasc Risk Rep 2016;10:21.
22. Benoit JL, Khatri P, Adeoye OM, et al. Prehospital triage of acute ischemic stroke patients to an intravenous tPA-ready versus endovascular-ready hospital: a decision analysis. Prehosp Emerg Care 2018;:22:722-733.
23. Holodinsky JK, Williamson TS, Demchuk AM, et al. Modeling stroke patient transport for all patients with suspected large-vessel occlusion. JAMA Neurol 2018;75:1477-1486.
24. Miller JB, Merck LH, Wira CR, et al. The advanced reperfusion era: implications for emergency systems of ischemic stroke care. Ann Emerg Med 2017;69:192-201.
25. Varelas PN, Schultz L, Conti M, et al. The impact of neuro-intensivist on patients with stroke admitted to a neurosciences intensive care unit. Neurocrit Care 2008;9:293-299.
26. Knopf L, Staff I, Gomes J, et al. Impact of a neurointensivist on outcomes in critically ill stroke patients. Neurocrit Care 2012;16:63-71.
27. Menon BK, Saver JL, Goyal M, et al. Trends in endovascular therapy and clinical outcomes within the nationwide Get With The Guidelines-Stroke registry. Stroke 2015;46:989-995.
28. Darehed D, Norrving B, Stegmayr B, et al. Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: a Swedish multicenter register study. Eur Stroke J 2017;2:178-186.
29. Rincon F, Mayer SA, Rivolta J, et al. Impact of delayed transfer of critically ill stroke patients from the emergency department to the neuro-ICU. Neurocrit Care 2010;13:75-81.