Health IT

Cleveland Clinic’s “ER on wheels” gets the right care to stroke patients fast

Cleveland Clinic Art

Less than a month after rolling out its Mobile Stroke Unit, an ambulance equipped with all the necessary elements of comprehensive stroke care, the Cleveland Clinic says a critical demand is being filled, and projections could already double within the first year.

Dr. Peter Rasmussen, director of Cleveland Clinic’s Cerebrovascular Center, said that after just three weeks, the effort has treated about 17 strokes, while another 50 cases were suspected strokes. For the year, Cleveland Clinic anticipates it will treat at least another 40 stroke patients just in Cuyahoga County, possibly doubling that number if it extends the physical footprint of the nearly $1 million ambulance.

The motivation behind taking stroke care on the road, directly to the patient, was borne out of a desire to both improve on stroke care, when minutes and seconds matter greatly, as well as the exploration of using technology to curb healthcare costs, Dr. Rasmussen said, noting that between $60 million and $80 million is spent on stroke care just in Cuyahoga County.


“For a long time we felt that, despite a well-codified program for stroke care, that patients who were suffering from strokes were not being treated in a timely enough fashion,” he said. “We just didn’t feel like we were making enough of a difference in the Cleveland area.

“A lot of this was done with an eye on the changes in healthcare,” he added, referring to new payment models and ACOs and the like. “This was one of the ways we thought we’d reduce costs.”

Cleveland Clinic anticipates it can save between $2 million and $4 million in the first year, depending on the number of patients treated.

The effort is modeled on the German practice of deploying an expert care team to stroke victims as soon as possible, Dr. Rasmussen said, but it differs in one key area made possible through advances in technology — the Mobile Stroke Unit does not deploy a physician, but instead utilizes a telemedicine unit, a portable CT scanner and 4G broadband video connections that collectively permit for mobile care that can be closely monitored from a hospital setting.

A pilot study at Charité-Universitätsmedizin Berlin found that using a mobile stroke team cut 30 minutes off of the time it takes to administer tPA for ischemic stroke patients, which account for 87 percent of all strokes. Officials with the Cleveland Clinic visited Berlin and decided to try the approach locally, where 5,600 stroke patients are hospitalized each year, in Cuyahoga County.

The unit, essentially “an emergency room on wheels,” Dr. Rasmussen said, is capable of taking labs, brain scans and administering clot-busting drugs. A neurologist can monitor the unit from the hospital and offer diagnosis or direct the unit to the appropriate facility. All of that is typically done after the patient arrives at an ER, and the time it takes to determine critical details, like what type of stroke is occurring, can severely impact the outcome for the patient, Dr. Rasmussen said.

The mobile unit can quickly determine what type of stroke is taking place, which in turn dramatically cuts down the time to deliver the tPA to ischemic stroke victims or determine the appropriate treatment for other stroke victims.

“We were spending an enormous amount of money every year just moving (stroke patients) around the system,” Dr. Rasmussen said.

The Mobile Stroke Unit, which is comprised of a paramedic, a critical care nurse, a CT technologist and an EMS driver, has been integrated into the 9-1-1 dispatch system in the city of Cleveland. The approach was made possible with the support from the Maltz Family Foundation of the Jewish Federation of Cleveland. The $1 million gift will support the Mobile Stroke Unit in Cleveland and research to study how the unit affects patient outcomes.

Dr. Rasmussen said the Cleveland Clinic may consider expanding the approach to a satellite location in Florida. He also said ambulance companies and health systems will likely start adopting similar practices as both a means to improve outcomes while curbing costs.

“I do think these remote technologies are going to be more applicable in the EMS setting,” he said. “Our hope is there will be broad adoption and savings in all of the healthcare system. If a hospital system really does the analysis on what they’re spending on stroke care, they’ll rapidly come to the same conclusion we did.”

No comments