USA Today highlights issue of volume and location for optimal stroke care

By Robert Davis, USA Today

HOUSTON — When fire department paramedics found 50-year-old Gerald Booker unable to drive, his left side weak and his speech slurred because of an apparent stroke, they told the yard laborer he was going for a ride.

Instead of stopping at hospitals closer to his home in the Pleasantville neighborhood of this sprawling city, the paramedics took Booker to Memorial Hermann Hospital, one of more than 660 hospitals across the USA that specialize in treating strokes.

As Booker was driven past the other hospitals on a recent Friday afternoon, he became part of a growing national — and still debated — trend aimed at improving the quality of medical care for strokes. Bypassing closer hospitals to rush people with blood clots or bleeding in their brains to specialty hospitals is an increasingly common way to deliver the most advanced care as soon as possible.

The treatment model is similar to the one developed years ago to help save the lives of those severely injured in accidents or by violence by passing local hospitals to reach one of the 255 U.S. trauma centers.

Likewise, some big-city emergency medical services take people who are having heart attacks to hospitals with fast-moving cardiac teams. Those specialists have shown they can routinely insert a catheter to clear a heart blockage faster than neighboring facilities.

The idea behind the specialty center trend — whether in treating strokes, trauma or heart attacks — is the belief that staffs in such facilities move faster and perform better than those in other hospitals, making up for any extra minutes a patient spends on the road.

A 2007 study in the journal Neurology examined more than 26,000 stroke patients admitted to 606 Canadian hospitals and found there were more adverse outcomes such as death for those treated in "low-volume" facilities — those dealing with fewer than 50 strokes a year — than in high-volume centers that treat 100 or more strokes annually.

"What you get at a stroke center versus a community hospital is a more in-depth and higher level of care," says James Grotta, chairman of the neurology department at Hermann, which is part of the University of Texas Health Science Center. "We see twice the number of stroke patients as the next hospital in this city. Like anything else, it's practice, practice, practice. The more you have done it, the better you are going to be at it."

But some in the medical community are skeptical about emergency crews bypassing community hospitals in favor of farther-away stroke centers. They say many patients who don't stand to benefit from cutting-edge and often experimental care at specialty centers could get quality care at smaller hospitals.

Click here for the complete article. (SOURCES: Advisory Board Daily Briefing , www.advisory.com, August 12, 2008; USA Today , www.usatoday.com, August 12, 2008)