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Neuro-HM Gains Numbers, Momentum


“Enter The Neurohospitalist” might sound like a medical spoof of a Bruce Lee movie, but it’s really a subspecialty’s announcement that it’s here to stay.

The clever moniker was the name of a plenary session at the 8th New York Symposium on Neurological Emergencies & Neurological Care, sponsored by Columbia University’s Center for Continuing Medical Education. The two-hour presentation on neurology’s take on HM was a new feature for the annual meeting, and to presenter David Likosky, MD, SFHM, hospitalist and stroke program director at Evergreen Hospital Medical Center in Kirkland, Wash., it was the latest sign that the field of HM is cementing its future.

“The neurohospitalist world right now is where the hospital medicine world was, say, ten, fifteen years ago,” says Dr. Likosky, who is board-certified in both neurology and internal medicine.

Multiple fields have adopted the HM model, to the point that SHM is holding its first national specialty hospitalist meeting, Focused Practice in Hospital Medicine, on Nov. 4 in Las Vegas. The meeting is designed to help promote networking of people interested in the hospitalist model in various specialties, as well as to help identify issues related to those specialties. Click here for more information and registration.

But even within the growth of speciality hospitalist models, neurology might be the cohort embracing it the fastest. Dr. Likosky estimates there are 500 neurohospitalists practicing nationwide. The Neurohospitalist Society held its first meeting earlier this year, and the field’s first textbook, which he is contributing to, is set for release in November. The Academy of Neurology has a dedicated neurohospitalist section. And the subspecialty even has its own quarterly journal, The Neurohospitalist.

There is now a critical mass of neurohospitalists. There’s also an increasing recognition by the neurointensivists that someone has to help them take care of these patients, either before they get to the unit or when they come out of the unit.

—David Likosky, MD, SFHM, hospitalist, stroke program director, Evergreen Hospital Medical Center, Kirkland, Wash.

“There is now a critical mass of neurohospitalists,” Dr. Likosky says. “There’s also an increasing recognition by the neurointensivists that someone has to help them take care of these patients, either before they get to the unit or when they come out of the unit. … Most hospitals don’t have neurointensivists, but they have very ill neurology patients. That’s another niche for neurohospitalists. All specialties of intensivists are looking for help with these patients.”

Another panelist at the four-day Manhattan conference, William D. Freeman, MD, assistant professor of neurology at the Mayo Clinic in Jacksonville, Fla., says the continued success of the field will be judged on data. He says three areas of potential “low-hanging fruit” to focus on are:

  • Increased use of intravenous tissue plasminogen activators (tPA). The FDA-approved “clot-busting therapy” has been shown to reverse the effects of ischemic stroke if given within a time-sensitive window of therapeutic opportunity.
  • Reduced length of stay for stroke patients. Adherence to best practices, Dr. Freeman says, will most effectively reduce patient stays and will be the ones that also demonstrate quality and patient-safety attributes.
  • Focus on stroke patient metrics. Administrators often focus on quality measures that are easily identifiable; Dr. Likosky says new programs have to be able to show they can meet those thresholds.

“Hospital administrators are new to the concept of a neurohospitalist,” Dr. Likosky adds. “It’s easier in that they get the hospitalist model because that’s been around for so long, but figuring out the expense of a neurohospitalist program, how that functionally works, are there enough volumes, are all questions that are being asked.”

Listen to more from Dr. Likosky

Still, Drs. Freeman and Likosky agree that the advantages of the subspecialty—everything from physicians’ quality of life to newly satisfied specialists in other departments (who will have a quicker neuro consult available)—mean the nascent specialty can continue to grow in numbers and influence.

“The future is bright for neurohospitalists,” Dr. Freeman says.

Richard Quinn is a freelance writer based in New Jersey.

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