New look at stroke response: Mobile physicians

Many patients living in rural areas don’t have easy access to specialized or emergency care. When they face conditions like strokes, every minute counts when trying to get them the treatment they need.

Rather than having patients transferred to hospitals with specialized stroke care, new research from the University of Missouri School of Medicine found that mobile physicians, doctors who travel to the patient, provided faster stroke treatment and increased odds for functional independence in stroke cases treated with a mechanical thrombectomy.

Although the distance from one hospital to the other would be the same for physician or patient, transferring a physician takes significantly less time, said study author Dr. Adnan Qureshi.

“The issue that prolongs patient transfer is the complexity involved in transferring a high-risk patient,” Qureshi said. “The patient needs critical care support during the transfer, which requires time to coordinate. The patient also must be stable enough for transfer by a helicopter. These issues are not a consideration when a physician travels to the patient.”

Qureshi examined 12 studies involving physician transfers and observed 1894 patient outcomes. He found transferring physicians was associated with shorter time intervals between stroke onset and treatment, which has positive implications for treating emergencies in patients who live in rural areas, he said.

“Physician Transfer Versus Patient Transfer for Mechanical Thrombectomy in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis” was recently published in the Journal of the American Heart Association.

“This may be applicable to other scenarios, where time lost in the patient transfer process may have adverse consequences for patient outcomes,” Qureshi said.

There are some limitations in transferring physicians. For example, rural hospitals or clinics may not have the appropriate equipment or space needed to treat patients, even if doctors can travel there. Additionally, facilities may lack nurses and technicians with experience in procedures like a mechanical thrombectomy, and it may be difficult to coordinate with a different hospital system.

“The potential benefit in providing acute treatment to a larger group of patients may incentivize facilities to develop the infrastructure needed to support this effort,” Qureshi said. “Going to the patient, and not waiting for them to come to you, could help save a lot of lives.”

Dr. Adnan Qureshi is a professor of clinical neurology at the MU School of Medicine and the program director of endovascular surgical neuroradiology fellowship at MU Health Care. He received his medical education at Quaid-i-Azam University Islamabad, completed his residency at Emory University and finished his fellowships at Buffalo State University and Johns Hopkins University Hospital.

In addition to Qureshi, MU authors included Dr. Camilo Gomez and Dr. David Mehr. This study was a collaboration with members from the Zeenat Qureshi Stroke Institute in Minnesota, University Hospitals of Birmingham in the UK, Johns Hopkins University in Maryland and the TEMPiS telestroke center, München Klinik, Academic Ludwig-Maximilians-University in Germany.