Because only a neurologist can provide a definitive stroke diagnosis and order intravenous administration of tissue plasminogen activator or tPA, which rapidly dissolves clots and saves lives and brain cells when given soon after the event, the delays were disastrous for many patients.
“Time is brain and brain cells,” said Dr. Juan Grau, an assistant professor of surgery at Columbia University College of Physicians and Surgeons in New York. “The early diagnosis is crucial.”
Bon Secours' door-to-needle time for tPA administration averaged an unacceptably high 71 minutes across the system. That was well above the maximum 60 minutes recommended by patient advocacy groups. Bon Secours' St. Francis Health System in Greenville, S.C., had a 91-minute door-to-needle performance in 2010.
Officials at first responded by asking staff neurologists to work extra hours. Few took up the offer fearing burnout in the gut-wrenching grind of the ER. “Very few like treating stroke patients,” said Tim Shephard, executive director of Bon Secours' neuroscience institute and vice president of its neuroscience service line.
Some of its hospitals tried to hire more neurologists, but they bumped into the nationwide shortage. The demand for the specialty continues to outpace the supply, according to the American Academy of Neurology. The current 11% shortage is expected to grow to 19% by 2025.
Bon Secours turned next to hiring temporary neurologists—the locum tenens solution. But it was simply too expensive, Shephard said.