Dallas, TX - Twenty years of physician suffering ended abruptly Monday after the American Stroke Association (ASA) announced a dramatically expanded 24-hour tPA stroke window protocol to better accommodate doctors' increasingly hectic schedules.
"Recent apologies by the American Board of Internal Medicine forced us to reevaluate our priorities as an organization. We now understand just how disruptive our three hour tPA window has been on doctors' lives and for that we are deeply sorry," said ASA President Dr. Jan Fleming.
With the new 24-hour window, ASA officials are hoping to give doctors much greater flexibility in planning emergent tPA administration around their busy days.
"Now is the time to start putting physician satisfaction first or we're going to be left with a nation of doctors who only work at The VA Spa," said Dr. Fleming, the ASA's first private practice ASA President.
Some neurologists wasted no time taking advantage of the new doctor-friendly protocol. "Last month I would have quit after the first nine [holes] of a stroke alert. Now, I can get in 36 holes, watch Tiger, drink a couple beers and not have to worry about showing up late to the tPA window," said Dr Bazyli Baczewski, a neurologist who has never made it to a stroke alert before the 3-hour window. Not ever. Not even once.
Other neurologists have already started pushing for once-daily tPA rounds at their hospital in conjunction with a hospitalist run 24-hour hemiplegia observation unit. "With the new 24-hour window, it doesn't make sense for me to interrupt my drug rep lunch, miss my kid's soccer game, or cancel my front row tickets to Taylor Swift for emergent tPA. Homonymous hemianopsia can wait until the morning for whomever is on call at that time," said Neurologist Dr. Agnieszka Sobkowiak, the world famous homo hemi expert.
Unfortunately, not every community is lucky enough to have within-24-hours access to a tPA Neurologist. Since 2003, tPA decisions for stroke patients in rural America have generally been punted to the on-call physician assistant. In critical access hospitals with only access to nurse practitioners, the American Academy of Physician Assistants (AAPA) recommends transferring tPA candidates to other critical access hospitals that employ physician assistants. President of the AAPA Don Witmore explains.
"The American Academy of Family Physicians (AAFP) and the American Association of Nurse Practitioners (AANP) got together a few years ago and decided since tPA has PA in it, we were the most natural fit to make the call."
But, with the growing army of physician assistant assistants caring for rural America, having PAs make the call isn't the straightforward decision it used to be. "We are teaming with pharmaceutical companies to develop tPAA so we can finally pass the torch and avoid getting stuck holding the bag," said Don.
With the 24-hour window now the standard of care,The American Academy of Emergency Medicine (AAEM) responded by officially punting tPA decisions out of the hands of ER doctors forever. "Now that we've added tPA to our master list of drugs outside the ER scope of practice, we are proud our doctors only ever have to memorize six drugs to make it through their shift: Phenergan, Dilaudid, Levaquin, Lasix, Lorazepam and Colace." said AAEM President Dr. Stan "Dilaudicet" Wilson.
Some ER physicians have already noticed a dramatic rise in their Press Ganey scores by allowing them more time to focus on patients threatening to call the CEO and less time on hemiplegic patients who can't even hold a pencil to fill out the survey anyway.
"Last week I had a mother complain about waiting for six minutes to have all seven kids seen for problems listening to her. I quickly wrote orders to admit my tPA candidate to the hospitalist and then to call them when the patient got upstairs so I could immediately attend to the mother's needs. Every kid got Levaquin and I got seven perfect scores. Bam! That's how the game is played," said one ER physician.
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"Recent apologies by the American Board of Internal Medicine forced us to reevaluate our priorities as an organization. We now understand just how disruptive our three hour tPA window has been on doctors' lives and for that we are deeply sorry," said ASA President Dr. Jan Fleming.
With the new 24-hour window, ASA officials are hoping to give doctors much greater flexibility in planning emergent tPA administration around their busy days.
"Now is the time to start putting physician satisfaction first or we're going to be left with a nation of doctors who only work at The VA Spa," said Dr. Fleming, the ASA's first private practice ASA President.
Some neurologists wasted no time taking advantage of the new doctor-friendly protocol. "Last month I would have quit after the first nine [holes] of a stroke alert. Now, I can get in 36 holes, watch Tiger, drink a couple beers and not have to worry about showing up late to the tPA window," said Dr Bazyli Baczewski, a neurologist who has never made it to a stroke alert before the 3-hour window. Not ever. Not even once.
Other neurologists have already started pushing for once-daily tPA rounds at their hospital in conjunction with a hospitalist run 24-hour hemiplegia observation unit. "With the new 24-hour window, it doesn't make sense for me to interrupt my drug rep lunch, miss my kid's soccer game, or cancel my front row tickets to Taylor Swift for emergent tPA. Homonymous hemianopsia can wait until the morning for whomever is on call at that time," said Neurologist Dr. Agnieszka Sobkowiak, the world famous homo hemi expert.
Unfortunately, not every community is lucky enough to have within-24-hours access to a tPA Neurologist. Since 2003, tPA decisions for stroke patients in rural America have generally been punted to the on-call physician assistant. In critical access hospitals with only access to nurse practitioners, the American Academy of Physician Assistants (AAPA) recommends transferring tPA candidates to other critical access hospitals that employ physician assistants. President of the AAPA Don Witmore explains.
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| 24-hour tPA stroke window brings relief to doctors everywhere! |
But, with the growing army of physician assistant assistants caring for rural America, having PAs make the call isn't the straightforward decision it used to be. "We are teaming with pharmaceutical companies to develop tPAA so we can finally pass the torch and avoid getting stuck holding the bag," said Don.
With the 24-hour window now the standard of care,The American Academy of Emergency Medicine (AAEM) responded by officially punting tPA decisions out of the hands of ER doctors forever. "Now that we've added tPA to our master list of drugs outside the ER scope of practice, we are proud our doctors only ever have to memorize six drugs to make it through their shift: Phenergan, Dilaudid, Levaquin, Lasix, Lorazepam and Colace." said AAEM President Dr. Stan "Dilaudicet" Wilson.
Some ER physicians have already noticed a dramatic rise in their Press Ganey scores by allowing them more time to focus on patients threatening to call the CEO and less time on hemiplegic patients who can't even hold a pencil to fill out the survey anyway.
"Last week I had a mother complain about waiting for six minutes to have all seven kids seen for problems listening to her. I quickly wrote orders to admit my tPA candidate to the hospitalist and then to call them when the patient got upstairs so I could immediately attend to the mother's needs. Every kid got Levaquin and I got seven perfect scores. Bam! That's how the game is played," said one ER physician.
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