ACUTE STROKE TEAMS - RESULTS OF A NATIONAL SURVEY

Background and Purpose-The sensitivity of the brain to brief periods o f profound ischemia or prolonged periods of modest ischemia mandates a n aggressive approach to acute stroke care. Past studies have shown th at many stroke patients do not receive acute care in an urgent and tim ely fashion. The formation of acute stroke teams (AST) is one approach that can be used to accelerate the delivery of acute stroke care. Met hods-We conducted a survey of major stroke program directors and neuro vascular experts throughout the United States. The survey focused on i ssues related to the presence of AST, their staffing, operational feat ures, and utilization at the surveyed programs and hospitals. Results- Surveys were returned from 45 of 60 centers. Ninety-one percent of the respondents indicated that they currently had an AST, with 66% formed between 1995 and 1997. Staffing of ASTs consisted of attending physic ians (95%), nurses or study coordinators (73%), fellows (49%), and res idents (46%). In almost all cases (98%), the AST was led by a neurolog ist or neurosurgeon, and 98% of the ASTs operated on a 24-hours-per-da y, 7-days-per-week basis. The most common call frequency was 2 to 3 ti mes per week (41%), followed by >5 calls per week (39%). In 59% of the cases, the teams cost less than or equal to$5000 per year to operate. The vast majority (78%) of ASTs responded within 10 minutes of receiv ing a call. Conclusions-The formation of ASTs is quite common at the s urveyed programs. Although staffing patterns vary, most teams are led by neurologists or neurosurgeons. The utilization of ASTs varies by fa cility, but they appear to be useful, with only a modest incremental f inancial cost. The use of ASTs may assist in providing more rapid medi cal care to stroke patients and increase the use of some acute therapi es, Extension of the AST concept to nonacademic hospitals appears feas ible.