June 1, 2017

To reach stroke patients faster, Johns Hopkins doctors take to the skies

Daily Briefing

    In a first-of-its-kind program, Johns Hopkins now flies a stroke specialist to patients in certain situations—a strategy that cuts down on costs and accelerates patients' access to care.

    Create a super-utilizer program

    Research has shown time is of the essence when someone suffers a stroke. According to studies, an individual who has suffered a stroke has a 91 percent chance of survival if his or her blood flow is restored within 150 minutes of the event. But for each additional hour that the patient doesn't receive treatment, his or her chance for a good recovery drops by 10 percent.

    Traditional care—and shortcomings

    While IV drugs remain the most common stroke treatment, some patients with larger clots require a treatment called catheterization. This minimally invasive procedure involves inserting a catheter into an artery in the groin and snaking it through the body until it reaches the clot, at which point the physician threads another device through the catheter to grab the clot or administers drugs to dissolve it.

    However, despite research showing the treatment's success, and increased demand for it, few physicians are trained to perform the procedure. As a result, some stroke victims must be transferred from their original hospital to one that can provide the specialty care—a time-consuming process that providers say can further delay treatment and endanger patient health.

    "You put people in a helicopter, and they can become unstable," said Rafael Llinas, director of neurology at Johns Hopkins Bayview Medical Center. "You take them out of the safe hospital and put them in an unstable and uncertain environment."

    And transporting a patient can also be expensive, as it requires a lot of people and specialized equipment. "If you can imagine, transporting a sick patient, you need the nurses, you need the safety equipment, all the monitors, all that takes time, money, and weight and fuel is expensive," said Ferdinand Hui, a neuroradiologist at Johns Hopkins.

    A new method

    To address those concerns, Hui devised a transportation service called "helistroke," which transports physicians to their stroke patients via helicopter so that the patients are able to get the specialized care as fast as possible, but without moving. "Transporting me, it's just one person, no monitor, no other people," said Hui.

    Hui tested out the program in a case study conducted in January 2017. During the case study, Hui was flown from Johns Hopkins Hospital in Baltimore to Suburban Hospital in Bethesda, Maryland to treat a stroke victim with the catheterization procedure. The trip itself took Hui 19 minutes, and he managed to treat the patient—who had been identified at 11:12 a.m.—by 1:07 p.m.

    The entire process took about 77 minutes, the Baltimore Sun reports. While Hui said it would have taken about the same amount of time to perform the procedure at Johns Hopkins, the overall timeframe would have been significantly longer to account for needed transportation and surgical preparation time.

    The process also saves money: It costs about 20 percent less to transfer a physician than moving a patient between hospitals, according to Johns Hopkins. The average cost of transporting a physician is between $2,000 to $3,000, while the average cost of transporting a patient by helicopter is between $6,500 and $8,000.

    While the hospital caring for the patient currently covers the cost of physician transportation,  Hui is collecting more data to present the model to insurance companies. He believes that by getting a patient treated quicker, the hospital can save money by spending less on that patient over time.

    Looking ahead

    The helistroke program is one of several initiatives hospitals are taking to make the catheter treatments more accessible to patients. "The medical community is really grappling with this," said William Powers, chair of the department of neurology at the University of North Carolina at Chapel Hill. "It really is a formidable challenge. This is a technical skill that takes a lot of training and only a certain number of people can do it. How do we get the people who need it to the people who do it?"

    For instance, Powers and colleagues have streamlined the patient transportation process at their hospital by cutting out previously required steps in the process. The hospital can dispatch an ambulance or helicopter immediately upon getting a call from another medical facility, rather than having to register the patient or ensuring a bed is available first—those administrative details now get resolved after the transportation departs, Powers said.

    As for the helistroke program, Hui doesn't necessarily envision it as a long-term plan for a larger hospital like Suburban, where he is working with the administration to establish 24/7 stroke care. Rather, he said the strategy could be most beneficial for smaller hospitals and hospitals in rural locations, which might not have access to such specialized treatment (Sofastaii, WMAR Baltimore, 5/30; McDaniels, Baltimore Sun, 5/30).

    Create a super-utilizer program

     Create a super-utilizer program

    Every population health manager develops a strategy to manage high-risk, high-cost patients. Many of these super-utilizer programs start small, but as they expand, leaders take the opportunity to re-evaluate program design—from appropriate patient recruitment through graduation.

    This guide offers a blueprint for implementing a super-utilizer program and measuring success across six steps.

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