Abstract W P337: Going to War for Stroke: The Experience of Establishing a Comprehensive Stroke Center in the United States
Background: Leading cultural change and performance improvement within a Stroke Center is often associated with resistance to increased workload and resources. We sought to understand neurologists’ experiences with transition to high performing U.S. Comprehensive Stroke Centers (CSC).
Methods: Qualitative interviews were used to develop a survey for physicians currently or formerly working in CSC leadership positions identified thru listserv, fellowship directors, and web. The survey was 29 items with 6 items tied to DSM-IV PTSD experiential criteria and 3 qualitative items. Quantitative data were entered and analyzed in SPSS; qualitative data were analyzed to determine themes.
Results: 48 CSC directors responded: 60% fellowship trained vascular neurologists (VN); 65% certified VN; 8% neurocritical care certified; 6% interventionalists. Sites were 67% academic; this was the first leadership position for 54%, with 9.3+6.5 (median 8) years as program leader. Prior to assuming leadership, tPA rates averaged 2.8%+4.8%, median 1.2%, with 40% not giving tPA; leader tPA rates averaged 12.1%+8.7%, median 9.5% (mean diff 9.1; 95% CI 6.9-11.3; p<0.001). Perceptions were dichotomized by agreement (Table); 21% met 1 PTSD criterion, while 12.5% met 6 criteria. Neurologists were identified as most supportive (44%), but also most commonly (27%) seen as least supportive. Strong intent to leave was 20%, while 33% were intent on staying. Insufficient pay (33%) and lack of hospital/physician administrative support (33%) were the most common reasons for dissatisfaction. Qualitative themes included need for “Authentic Support” from hospital/physician administrators’ and “Vigilante’ Caring” tied to persistence/work ethic.
Conclusions: Despite challenges, CSC leaders are highly motivated, although rates of experiences tied to PTSD approaches that of soldiers. Hospital/physician administrators must improve support of stroke warriors to ensure optimal performance.
Author Disclosures: A.W. Alexandrov: None. V. Swatzell: None. F. Cudlip: None. A.V. Alexandrov: None. S. Martin-Schild: None.
- © 2014 by American Heart Association, Inc.