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Stroke treated significantly faster and just as safely by medical residents
Date:2/24/2009

es, emergency medicine. But while residents are almost always immediately available in the emergency room, neurologists may not be, and the time spent waiting for such a physician to be summoned can allow harm from the stroke to intensify and spread.

For the study, which began in 2004, neurology residents at Barnes-Jewish Hospital started taking an annual three- to four-hour mini-course on use of tPA. The course taught them how to appropriately choose candidates for tPA and how to administer it. After residents were given the authority to administer tPA, a committee of medical faculty and staff met monthly to review the case of every patient evaluated for stroke treatment, giving residents feedback on their decision-making.

Researchers assessed the results by comparing the outcomes and complications of stroke patients treated by residents from 2004 to 2007 against the same data for stroke patients treated by attendings and fellows from 1998 to 2002. There was no significant increase in negative outcomes, including bleeding in the brain, and door-to-needle times were notably shorter for patients treated by residents.

"It makes senseresidents are always in house, and if they can make a direct decision on treatment without waiting for an attending or a fellow to respond to a pager, then the treatment time is going to be shorter," says lead author Andria Ford, M.D., a Washington University neurologist at Barnes-Jewish Hospital.

Neurology residents at Barnes-Jewish Hospital continue to regularly train in tPA usage and to have the authority to administer tPA.

Given an academic medical center where the resources exist to expand resident training and provide regular feedback, Lee thinks the model can be applied "across the boardnot just to neurologists in training but to emergency department physicians in training, for example."

Lee characterizes the study as the culmination of two major branches of the work of senior a
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Contact: Michael C. Purdy
purdym@wustl.edu
314-286-0122
Washington University School of Medicine
Source:Eurekalert

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