Care Of Stroke Patients Research Articles

Comorbidity and outcomes among hospitalized patients with stroke: a nationwide inpatient analysis.

We aimed to characterize healthcare utilization and comorbidity outcomes among hospitalized elderly stroke patients using a nationally representative dataset in the United States. Using the 2019 National Inpatient Sample, patients aged 65 years or older with and without comorbidities who were hospitalized for acute stroke were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Patient comorbidities were identified with the use of the Elixhauser Comorbidity Index. The prevalence of comorbidities, in-hospital mortality, length of stay, and total hospital costs were analyzed for these patients. Within 451,945 patients (mean age 78 years, 54.1% women, 73.7% white), we observed that more than 90% of patients had a minimum of two comorbidities. The median number of comorbidities was 4.0 (IQR 3.0-6.0). There was significant variation in the prevalence rate of comorbidities. The five most common comorbidities were uncomplicated hypertension (55.4%), paralysis (40.1%), congestive heart failure (39.8%), various neurological illnesses (38.3%), and complex hypertension (32.5%). After adjusting for patient- and hospital-level characteristics, a statistically significant association was observed between comorbidities and various adverse outcomes. Specifically, comorbidities were found to be significantly associated with an increased risk of inpatient mortality (odds ratio: 1.09; 95% CI: 1.08-1.11; P < 0.001), a longer duration of hospitalization (0.68 days; 95% CI: 0.66-0.71; P < 0.001), and higher total cost ($1,874.9; 95% CI: 1,774.6-1,975.2; P < 0.001). This national data suggests that comorbidity is common among hospitalized older stroke patients and substantially increases the healthcare burden and inpatient mortality in the United States. These findings underscore the integration of comorbidity management into the care of older stroke patients.

Medical demography at stroke centers: Current situation in France

IntroductionFollowing the 2010–2014 French national stroke action plan, the number of stroke center (SC) has gradually increased in France, allowing a homogeneous coverage and access to neurovascular care in organized and territorially defined structures. However, operational difficulties within SCs have been progressively reported over the last few years. The objective of this study was to identify the medical staff shortages in SC that may contribute to these difficulties. MethodsA survey on the medical staffing level as of January 1, 2021 was sent to all French SC managers. Specific questions related on vacancies, need of interim medical staff, and participation in out-of-hour healthcare services. ResultsAmong the 139 SC managers contacted, 122 (88%) filled in the questionnaire. Analysis of the data showed that over 879 physician positions opened, 163 (18.5%) remained vacant for a mean of two years, and that in 51 SCs (41.9%), more than two positions were unfilled. In 13 of these 51 SCs, the out-of-hour healthcare services relied on less than four practitioners, defining a critical situation, and three other SCs had to close temporarily (2) or permanently (1). Moreover, 39.2% of SCs with at least one vacancy used interim physicians, for a median period of 12.5 weeks/year (IQR 5–18). ConclusionThis study highlights the significant medical staff shortage in French SCs. In the absence of urgent measures, more SCs will close, jeopardizing the regional network and access to care for stroke patients.

Automated Quantifiable Assessments of Sensorimotor Function Using an Instrumented Fragile Object.

Accurate assessment of hand dexterity plays a critical role in informing rehabilitation and care of upper-limb hemiparetic stroke patients. Common upper-limb assessments, such as the Box and Blocks Test and Nine Hole Peg Test, primarily evaluate gross motor function in terms of speed. These assessments neglect an individual's ability to finely regulate grip force, which is critical in activities of daily living, such as manipulating fragile objects. Here we present the Electronic Grip Gauge (EGG), an instrumented fragile object that assesses both gross and fine motor function. Embedded with a load cell, accelerometer, and Hall-effect sensor, the EGG measures grip force, acceleration, and relative position (via magnetic fields) in real time. The EGG can emit an audible "break" sound when the applied grip force exceeds a threshold. The number of breaks, transfer duration, and applied forces are automatically logged in real-time. Using the EGG, we evaluated sensorimotor function in implicit grasping and gentle grasping for the non-paretic and paretic hands of 3 hemiparetic stroke patients. For all participants, the paretic hand took longer to transfer the EGG during implicit grasping. For 2 of 3 participants, grip forces were significantly greater for the paretic hand during gentle grasping. Differences in implicit grasping forces were unique to each participant. This work constitutes an important step towards more widespread and quantitative measures of sensorimotor function, which may ultimately lead to improved personalized rehabilitation and better patient outcomes.

The cell-specific roles of Nrf2 in acute and chronic phases of ischemic stroke.

Ischemic stroke refers to the sudden loss of blood flow in a specific area of the brain. It is the fifth leading cause of mortality and the leading cause of permanent disability. The transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2) controls the production of several antioxidants and protective proteins and it has been investigated as a possible pharmaceutical target for reducing harmful oxidative events in brain ischemia. Each cell type exhibits different roles and behaviors in different phases post-stroke, which is comprehensive yet important to understand to optimize management strategies and goals for care for stroke patients. In this review, we comprehensively summarize the protective effects of Nrf2 in experimental ischemic stroke, emphasizing the role of Nrf2 in different cell types including neurons, astrocytes, oligodendrocytes, microglia, and endothelial cells during acute and chronic phases of stroke and providing insights on the neuroprotective role of Nrf2 on each cell type throughout the long term of stroke care. We also highlight the importance of targeting Nrf2 in clinical settings while considering a variety of important factors such as age, drug dosage, delivery route, and time of administration.

Variation in Ischemic Stroke Payments in the USA: A Medicare Beneficiary Study

Introduction: The growing cost of stroke care has created the need for outcome-oriented and cost-saving payment models. Identifying imbalances in the current reimbursement model is an essential step toward designing impactful value-based reimbursement strategies. This study describes the variation in reimbursement fees for ischemic stroke management across the USA. Methods: This Medicare Fee-For-Service claims study examines USA beneficiaries who suffered an ischemic stroke from 2021Q1 to 2022Q2 identified using the Medicare-Severity Diagnosis-Related Groups (MS-DRGs). Demographic national and regional US data were extracted from the Census Bureau. The MS-DRG codes were grouped into four categories according to treatment modality and clinical complexity. Our primary outcome of interest was payments made across individual USA and US geographic regions, assessed by computing the mean incremental payment in cases of comparable complexity. Differences between states for each MS-DRG were statistically evaluated using a linear regression model of the logarithmic transformed payments. Results: 227,273 ischemic stroke cases were included in our analysis. Significant variations were observed among all DRGs defined by medical complexity, treatment modality, and states (p < 0.001). Differences in mean payment per case with the same MS-DRG vary by as high as 500% among individual states. Although higher payment rates were observed in MS-DRG codes with major comorbidities or complexity (MCC), the variation was more expressive for codes without MCC. It was not possible to identify a standard mean incremental fee at a state level. At a regional level, the Northeast registered the highest fees, followed by the West, Midwest, and South, which correlate with poverty rates and median household income in the regions. Conclusions: The payment variability observed across USA suggests that the current reimbursement system needs to be aligned with stroke treatment costs. Future studies may go one step further to evaluate accurate stroke management costs to guide policymakers in introducing health policies that promote better care for stroke patients.

31 Stroke early supported discharge: continuing to improve patient and organisational outcomes

Abstract Background Approximately 6,000 people in Ireland had a stroke in 2020. Early Supported Discharge (ESD) is an international model of care for stroke patients. ESD improves patient outcomes while facilitating a faster discharge, through provision of stroke specific rehab at home. ESD can be expected to improve disability outcomes, quality of life and reduce length of hospital stay. A pilot ESD service was introduced in an acute hospital in 2021 and continues to provide stroke rehab for patients living within a 30-minute drive from an acute hospital. Methods A retrospective re-audit on routine data from 113 patients who partook in ESD from January 2021 to December 2022 from an acute hospital. Data was extracted from the ESD database and analysed. Results Implementation of an ESD service over 24 months between 2021 and 2022 achieved the following: (i) 50% increase in number of bed saving days between 2021 and 2022; (ii) In both 2021 and 2022, the percentage of stroke patients discharged with ESD was 25% of the total number of stroke patients; (iii) The average LOS of a stroke patient accepted to the ESD service continues to decrease. In 2021, average LOS for ESD patients was 11.7 days; 2022 it was 11 days; (iv) The number of stroke patients accepted by ESD service remains relatively unchanged. In 2021, 57 patients and in 2022, 56 patients were accepted to ESD and (v) Total FIM/FAM scores from admission to discharge with ESD continue to increase. In 2021, 8.1% increase in functional outcomes were recorded. In 2022, that increased to 9.5% demonstrating an improving independence levels when discharged with ESD. Conclusion The ESD service in an acute hospital continues to demonstrate Organisational and patient benefits. Participation in ESD rehabilitation impacted positively on functional performance as captured using the FIM-FAM. Ongoing implementation of ESD aims to continue to have a positive impact on length of patient stay, bed saving days and functional outcomes.

Nursing Care for Stroke Patients: Current Practice and Future Needs.

Stroke is the second leading cause of death and the third leading cause of disability worldwide. Stroke nurses play an important role in the care of patients living with stroke by using best practices and adhering to stroke-management guidelines. This study aims at examining the current nursing practice for stroke patients in Saudi Arabia. A cross-sectional descriptive design was used to collect data from nurses working in the stroke unit and intensive care unit between the period of February and June 2022 using electronic self-administered questionnaires. A convenience sample of 131 nurses who provided care for stroke patients was enrolled. Significant differences in nursing practice were found between the stroke units and the intensive care units regarding the activation of the stroke code, X2 (4, N = 131) = 48.34, p < 0.001; transferring stroke patients to a designated bed, X2 (4, N = 131) = 48.74, p = 0.002; applying the NIHSS, X2 (4, N = 131) = 70.11, p < 0.001; using the modified Rankin scale, X2 (4, N = 131) = 61.24, p < 0.001; providing intervention for neglect syndrome, X2 (4, N = 131) = 44.72, and hemianopsia, X2 (4, N = 131) = 39.22; screening for poststroke depression, X2 (4, N = 131) = 101.59, p < 0.001; assessing for psychosocial needs, X2 (4, N = 131) = 74.44, p < 0.001, and encouraging patients to express their feelings, X2 (4, N = 131) = 58.64, p < 0.001; educating patients and families about stroke prevention, X2 (4, N = 131) = 40.51, p < 0.001. As per the results of the study, there is an urgent need for stroke units run by specialized stroke nurses to provide early stroke management and improve survivors' outcomes. Structured stroke-care programs are needed to improve nursing practice and meet the international standard of stroke care.

Nursing Care of Delaware's Stroke Patients.

This article will highlight essential nursing care in each aspect of the continuum of stroke care. Nursing interventions will be covered from primary stroke prevention through the transitions needed for healthy return to the community and secondary stroke prevention.

The Relationship between Burden and Quality of Life for Caring for Stroke Patients

This study aims to determine the relationship between burden and quality of life of stroke caregivers at the Bukittinggi National Stroke Hospital Polyclinic. This type of research is analytic research with a cross sectional approach. The analysis used in this study uses univariate analysis and bivariate analysis. The results of the study are 1. Less than half of the caregivers have a moderate burden in caring for stroke patients. 2. More than half of caregivers have a poor quality of life. 3. There is a relationship between the burden and the quality of life of stroke caregivers.

Disparities in transitions of acute stroke care: The transitions of care stroke disparities study methodological report

ObjectiveThe Transitions of Stroke Care Disparities Study (TCSD-S) is an observational study designed to determine race-ethnic and sex disparities in post-hospital discharge transitions of stroke care and stroke outcomes and to develop hospital-level initiatives to reduce these disparities to improve stroke outcomes. Materials and methodsHere, we present the study rationale, describe the methodology, report preliminary outcomes, and discuss a critical need for the development, implementation, and dissemination of interventions for successful post-hospital transition of stroke care. The preliminary outcomes describe the demographic, stroke risk factor, socioeconomic, and acute care characteristics of eligible participants by race-ethnicity and sex. We also report on all-cause and vascular-related death, readmissions, and hospital/emergency room representations at 30- and 90-days after hospital discharge. ResultsThe preliminary sample included data from 1048 ischemic stroke and intracerebral hemorrhage discharged from 10 comprehensive stroke centers across the state of Florida. The overall sample was 45% female, 22% Non-Hispanic Black and 21% Hispanic participants, with an average age of 64 ± 14 years. All cause death, readmissions, or hospital/emergency room representations are 10% and 19% at 30 and 90 days, respectively. One in 5 outcomes was vascular-related. ConclusionsThis study highlights the transition from stroke hospitalization as an area in need for considerable improvement in systems of care for stroke patients discharged from hospital. Results from our preliminary analysis highlight the importance of investigating race-ethnic and sex differences in post-stroke outcomes.

Functioning of the Integrated System of Care for Stroke Patients Treated with Mechanical Thrombectomy Based on the Case Report

Introduction. Mechanical thrombectomy is a treatment method used in the event of ischemic stroke, caused by obstruction of a large artery. This method is used to treat stroke in its acute phase. An integrated health care system is about placing the patient in need of help at the centre of the procedure. In such a system, the patient receives support and treatment methods in various fields and from various specialists.&#x0D; Aim. The aim of the work is to present the issue of introduction and implementation of the program of treatment of patients after stroke by means of mechanical thrombectomy.&#x0D; Case Report. The research material in the work was medical documentation of patients of the neurology department, and scientific literature. The research method was the individual case method, analysis of literature and medical documentation.&#x0D; Conclusions. A very well-implemented pilot program of mechanical thrombectomy treatment, with specific guidelines, standards, rules of conduct, contact methods, contributes to reducing mortality due to ischemia strokes. (JNNN 2023;12(2):92–97)

The Application Of Telerehabilitation To Post-Stroke Patients In The Covid-19 Pandemic Era

Background: Stroke is a cerebrovascular disease that causes sudden death. The blockage causes a lack of oxygen supply which can cause rupture of the arteries to the brain and death of the cells. The COVID-19 pandemic has affected stroke care through various aspects, many of which are associated with neurological symptoms and complications that occur due to delays in treatment. Therefore, the application of telerehabilitation can help support and care for patients with stroke by reducing the risk of transmission of COVID-19. Purpose: The aim of this study was to analyse the application of telerehabilitation to post-stroke patients during the COVID-19 pandemic. Method:The research method is in the form of a systematic review with literature search on primary sources online database, namely PubMed, Medline, and Google Scholar with a range of 2019 to 2021, selection of studies using a meta-analysis approach by answering questions using the PECOT/PICOS framework and analyzed using simplified approach. In this study, the number of articles found was 889 articles with six articles meeting the inclusion criteria. Results: The results of this study indicate that telerehabilitation is effective for stroke patients, but providing telerehabilitation must pay attention to the patient's and family's ability to use digital technology, the ability to understand rehabilitation programs, and also various aspects such as functional status: direct motor skills involving the upper extremities, balance, cardiorespiratory fitness, cognitive function, and the level of acceptance and eligibility of teletherapy by users (patients/families) at home so that the therapy program can run optimally. Conclusion: Telerehabilitation is effectively implemented in the era of the COVID-19 pandemic because it can provide support and help patients, families, and health services in providing care for stroke patients while reducing the risk of transmission of COVID-19. Keywords: Stroke; Pandemic; COVID-19; Telerehabilitation

Terapia endovascular en el tratamiento del ACV isquémico agudo. Perspectiva en Colombia

La aparición en este año de siete estudios que demuestran la superioridad de la terapia endovascular (TEV) sobre el tratamiento convencional de la trombólisis IV con t-PA en las primeras 4,5 horas posteriores al inicio del ataque cerebrovascular (ACV) isquémico agudo en pacientes con una obstrucción arterial proximal, establece un reto terapéutico para los neurólogos colombianos por el costo social que ocasiona la enfermedad y por las falencias que presenta nuestro sistema de salud para la atención óptima al respecto.&#x0D; Esta revisión crítica de los estudio MR Clean, Escape, Extend IA, Swift Prime, Revascat, Thrace y Therapy, así como de las guías 2015 de la American Heart Association (AHA), analizan la factibilidad e implementación de esta información en Colombia.&#x0D; La administración rápida de la terapia intravenosa con t-PA en estos estudios fortalece su implementación en el país e invita a generar protocolos que incluyan imágenes diagnósticas no invasivas como la angiografía cerebral por escanografía cerebral (CTA) o por resonancia magnética (MRA) que seleccionen a los pacientes con obstrucción proximal para brindarles lo más rápido posible el recurso de una TEV a través de una red hospitalaria del ACV.&#x0D; Los principales retos establecidos son los de allanar las diferencias entre el sector público y privado en la atención de pacientes con ACV isquémico agudo, dotar hospitales públicos con la tecnología y el talento humano que la TEV exige, e integrar una red nacional del ACV.

Budget impact of endovascular treatment for acute ischaemic stroke patients in the Netherlands for 2015-2021.

Endovascular treatment (EVT) has been proven to be both effective and cost-effective for patients with acute ischaemic stroke. We investigated the budget impact of large-scale implementation of EVT for acute ischaemic stroke patients in the Netherlands for 2015-2021. An analysis was performed from ahealthcare perspective as apreplanned substudy of the Multicenter Randomized Clinical trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN). Estimated yearly costs during follow-up after stroke for patients who had or had not been treated with EVT as add-on to usual care were linked to numbers of new patients retrieved from 2Dutch registries of EVT that started after the last inclusion in MR CLEAN (2014). Aggregated costs and costs per care sector were calculated based on prevalence using apopulation dynamic tool. From 2015, the yearly number of new acute ischaemic stroke patients receiving EVT increased almost threefold, from 812 in 2015 to 2,370 in 2021. The introduction of EVT plus usual care resulted in estimated net annual savings that increased from € 2.9million in 2015 to € 58million in 2021. Offering EVT as add-on to usual care for acute ischaemic stroke patients was increasingly cost saving from anational healthcare perspective but affected distinct healthcare sectors differently.

Global research trends on COVID-19 and stroke: A bibliometric analysis.

The pandemic of COVID-19 has had a profound influence on worldwide healthcare systems. Our study aimed to conduct a bibliometric analysis to explore the impact of COVID-19 on stroke and to highlight the major research trends in this field. We searched the original articles and review articles regarding COVID-19 and stroke from the Web of Science collection (WOSCC) database between January 1, 2020 and December 30, 2022. Subsequently, we performed bibliometric analyses and visualization using VOSviewer, Citespace, and Scimago Graphica. A total of 608 original articles or review articles were included. JOURNAL OF STROKE and CEREBROVASCULAR DISEASES published the most studies on this subject (n = 76), while STROKE was the source of the most-cited references (n = 2,393). The United States is the most influential country in this field, with the highest number of publications (n = 223) and citations (n = 5,042). Shadi Yaghi from New York University is the most prolific author in the field, while Harvard Medical School is the most prolific institution. In addition, through keyword analysis and reference co-citation analysis, three major research topics were identified: (i) the impact of COVID-19 on stroke outcomes (including risk factors, clinical characteristics, mortality, stress, depression, comorbidities, etc.); (ii) the management and care of stroke patients during the COVID-19 pandemic (including thrombolysis, thrombectomy, telemedicine, anticoagulation, vaccination, etc.); and (iii) the potential relationship and pathological mechanism between COVID-19 and stroke (including renin-angiotensin system activation, SARS-CoV-2 virus-induced inflammation leading to endothelial impairment, coagulopathy, etc.). Our bibliometric analysis provides a comprehensive overview of the current state of research on COVID-19 and stroke and highlights key areas of focus in the field. Optimizing the treatment of COVID-19-infected stroke patients and elucidating the underlying pathogenic mechanisms of COVID-19 and stroke co-morbidity are key areas of future research that will be beneficial in improving the prognosis of stroke patients during the ongoing COVID-19 epidemic.

What's the Future of Vascular Neurology?

The field of vascular neurology has made tremendous advances over the last several decades, with major shifts in diagnosis, treatment, prevention, and rehabilitation of patients with stroke. Furthermore, the individuals who are providing the care represent a different cohort than those who were caring for stroke patients 30years ago, with the increasing need for rapid decision-making for acute interventions and a larger workforce being needed to provide the many complicated aspects of care of stroke patients. Understanding the history of the field is critical before one can speculate about its future directions. In summarizing some of the past massive shifts in the past few decades, this review will discuss future opportunities and future challenges and will introduce the rest of this special issue focusing on vascular neurology in a post-thrombectomy era. Although thrombolysis and thrombectomy remain a major part of ischemic stroke management and care, in the coming years, there will likely be further modifications in how we provide the care, who provides it, how we train those individuals who provide it, where it is provided, and what data inform early management decisions.

Determining the factors influencing the selection of post-acute care models by patients and their families: a qualitative content analysis

BackgroundThis study conducted in-depth interviews to explore the factors that influence the choice of a post-acute care (PAC) model (inpatient rehabilitation hospital, skilled nursing facility, home health, and outpatient rehabilitation) among stroke patients and their families.MethodsWe conducted semi-structured, in-depth interviews of 21 stroke patients and their families at four hospitals in Taiwan. Content analysis was used in this qualitative study.ResultsResults revealed five main factors that influence respondents’ choice of PAC: (1) medical professionals’ suggestions, (2) health care accessibility, (3) continuity and coordination of care, (4) willingness and prior experience of patients and their relatives and friends, and (5) economic factors.ConclusionsThis study identifies five main factors that affect the choice of PAC models among stroke patients and their families. We suggest that policymakers establish comprehensive health care resources based on the needs of patients and families. Health care providers shall provide professional recommendations and adequate information to support decision-making, which aligns with the preferences and values of patients and their families. From this research, we hope to improve the accessibility of PAC services in order to enhance the quality of care for stroke patients.

The lifetime burden following stroke: Long term impact of stroke on survival and quality of life.

The absolute burden of stroke in Korea is ever growing. Many studies have explored the outcomes of mortality, quality of life (QOL), and/or economic burden with limited periods of observation. Relatively few have addressed the lifetime outcomes that are estimated beyond the limited observation period of study samples. By combining QOL and the survival functions over a lifetime horizon, our aims were to estimate the quality-adjusted life expectancy (QALE) and loss-of-QALE of patients with ischemic and hemorrhagic stroke in South Korea, and to compare them between genders. The survival function of stroke patients (n = 13,994) was estimated by the Kaplan-Meier's method from the National Health Insurance Service-National Sample Cohort of Korea (2002-2015), and then extrapolated to lifetime through a rolling-over algorithm. The QOL measurements, assessed by EuroQol 5-dimension (EQ-5D) questionnaire, of stroke patients (n = 474) were extracted from the Korea Health Panel (KHP, 2008-2018) to estimate the QALE. All stroke patients were categorized by sex and two types of stroke: ischemic and hemorrhagic. Age-, sex-, and calendar year-matched referents were simulated from the Korean life tables to be integrated with the general population's QOL from the KHP to estimate the QALE of the referents. We calculated the loss-of-QALE by comparing the above two sets of QALE. The QALE and loss-of-QALE for ischemic stroke were 10.8 and 6.1 QALYs (quality-adjusted life years), respectively, and 14.0 and 9.0 QALYs for hemorrhagic stroke. The loss-of-QALE in men was 3.0 QALYs larger than that of women with hemorrhagic stroke (p < 0.05), while the difference for ischemic stroke was much smaller and statistically insignificant at 0.6 QALYs. The lifetime impact of stroke in Korea is large, especially for males who survived hemorrhagic stroke. Future studies assessing the lifetime needs for long-term care of stroke patients are warranted to quantify the burden of stroke from the societal perspective.

Hemiplegia and oral health

Oral health problems are often neglected due to other problems that are thought to be more vital in stroke patients. However, oral health is a significant quality of life determinant and needs to be protected in stroke patients as well as general population. Moreover, problems such as hemiparesis, hemiplegia, dysphagia, balance and coordination disorder and cognitive dysfunction due to strokes have a very negative impact on the self -care and/or care support of the caregivers. In this study, we aimed to search a large number of health databases and make a compilation on oral health problems, impact on quality of life and solutions in stroke patients. Keywords ‘oral, dental, health, care, hygiene, dental, prosthesis, denture, tooth brushing, stroke, cerebrovascular and cardiovascular’ and combinations of these words were searched in the literature. Studies involving at least one subject for oral health in stroke patients were included in the review. In the literature, it was seen that the oral health of the stroke patients was discussed more about mastication, swallowing, dysphagia, nutrition, hygiene, prosthesis and quality of life. It was concluded that there are no sufficient assessment and care guides that can be used by stroke patients or caregivers, and the information of dentists, patients and caregivers about special care for stroke patients was not sufficient.

Stroke thrombolysis given by emergency physicians: The time is here

Emergency Medicine core clinical privileges include administration of thrombolytic therapy for myocardial infarction and stroke. However, emergency medicine providers have created their own paradigm to rely on neurology specialty consultation to treat acute stroke patients. A 2013 study supported by the American Academy of Neurology showed an 11% shortage of neurologists at that time and projected a 19% shortage by 2025. The lack of neurologists is a worldwide problem. To help ease the shortage, teleneurology and telestroke care has been implemented by neurologists, most notably for acute ischemic stroke (AIS) patients. We present a model in which an Emergency Medicine (EM) Stroke Champion (SC); an EM physician within our Neurologic Emergency Department, directs care for acute stroke patients at our comprehensive hub and primary stroke center spoke hospitals. The SCs independently treat patients with fibrinolytic therapy and provide teleneurology to fellow emergency physicians caring for acute stroke patients at spoke hospitals. Over nineteen months the SCs received 457 phone calls for patients meeting stroke alert criteria. Sixteen patients were deemed eligible for IV alteplase with one hemorrhagic conversion (6.25%). Sixty-four patients required transfer, and this was facilitated by the SCs. The concept of emergency physician SCs providing teleneurology consultation to other fellow emergency physicians was found to be feasible and safe. This model has the potential to be generalized not to just stroke champions, but to all emergency physicians to feel both confident and comfortable treating acute stroke patients.