The University of Colorado Neurohospitalist program commenced July 1, 2011. The program is housed within the internal medicine hospitalist program, and is modeled after that system. It is comprised of three neurohospitalists, Dr. William
Jones, Dr. Matthew West, and Dr. Jennifer Simpson, and one nurse practitioner, Alex Graves. Drs. Jones and Simpson are stroke specialists, while Dr. West compeleted a fellowship in neuroimmunology. Each spend eight months on the inpatient service, one half day of clinic per week and has four months of “academic” time. The inpatient service is divided into stroke and general neurology teams with an attending on each service while the third attending is on academic time. Each team has a primary service as well as a consultation service. The format
allows for each physician to be well known to the emergency department, internal medicine department, and other consulting services.
Housing the two hospitalist programs together allows for unique synergies. For example, the neurohospitalists and internal medicine hospitalists have partnered to create a quality improvement project involving acute ischemic stroke patients. “Target Stroke” was an initiative to reduce time to IV tPA treatment. The project began in July 2011, and 2 stages of intervention have occurred. The first stage changed the stroke alert criteria from 24 to 8 hours, streamlined the stroke alert protocol, added a pharmacist to the stroke alert paging system, and provided more regular feedback to the entire team involved in each patient’s care. The second stage included waving labs that are unlikely to be abnormal, placing all stroke alerts in the trauma room if possible, and expediting the CT scan. This project has been a tremendous success, and has decreased time to tPA in stroke patients, as shown in the chart below. This project was a great collaboration between the neurology and internal medicine hospitalist groups, the emergency department, pharmacy, and radiology.
Jennifer Simpson MD