Stroke Solution

Conclusion: Stroke Centers and Systems of Care

Managing patients with stroke is in many ways an ideal fit for the hospitalist model. From symptom onset, the patient with stroke challenges traditional approaches to care in multiple ways: variable presentation involving multiple neurologic symptoms, frequent systemic comorbidities and risk factors, highly variable disease course and sequelae, and the need for active and coordinated management throughout the continuum of care. The hospital physician should seek to improve the value of care by ensuring and facilitating consistent management according to established guidelines and by managing the transitions between phases of treatment.

SHM provides numerous valuable tools to the hospital physician for use in improving the care of patients with stroke, including diagnostic and assessment instruments and guidelines, algorithms and pathways for management of patients with stroke, sample standing orders from leading institutions, and resources that can be provided to patients and their families. All are available or downloadable from the SHM Web site, at www.hospitalmedicine.org/AM/Template.cfm?Section=Quality_Improvement_Resource_ Rooms&Template=/ CM/HTMLDisplay.cfm&ContentID=6566. Even (or perhaps especially) in the absence of higher-level systems dedicated to the care of patients with stroke, the hospital physician can serve as a critical linchpin in the optimization of patient outcomes following stroke. TH

Dr. Likosky is executive director, Evergreen Neuroscience Institute, Kirkland, Wash., as well as a hospitalist and neurohospitalist.

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