Task-shifting Carried out by an Emergency Department's Stroke Hotline and Medical Care Support Conducted by Nurse Practitioners Takeshi HIU 1,5 , Hiroaki OTSUKA 2 , Chikaaki NAKAMICHI 3 , Kazuya HONDA 1 , Chison GON 3 , Kazumi YAMASAKI 4 , Ayaka MATSUO 1 , Ichiro KAWAHARA 1 , Hiroshi IWANAGA 2 , Masahiro TOKUDA 2 , Takehiro ITOH 1 , Tomoya MORITSUKA 1 , Fumiya KUTSUNA 2 , Miki UENO 2 , Tomonori ONO 1 , Wataru HARAGUCHI 1 , Ryujiro USHIJIMA 1 , Keisuke TSUTSUMI 1 1Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center 2Department of Neurology, National Hospital Organization Nagasaki Medical Center 3Department of Emergency, National Hospital Organization Nagasaki Medical Center 4Clinical Research Center, National Hospital Organization Nagasaki Medical Center 5Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences Keyword: task-shifting , stroke hotline , drip and ship , nurse practitioner , transitions of care pp.781-792
Published Date 2020/9/10
DOI https://doi.org/10.11477/mf.1436204274
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 Our hospital serves as the main hub for eight remote island hospitals(RIHs)in Nagasaki Prefecture, Japan. The shortage of stroke physicians, which has led to overwork, is a major concern. Several “task-shifting” systems were adopted to avoid physician burnout.

 First, the emergency department established a hotline system for receiving emergency calls regarding a stroke, and which managed initial care until the stroke physicians arrived(called the Nagasaki Medical Center stroke hotline system:N-SHOT)in 2014. The rt-PA administration rate increased from 3.3% in the Pre-N-SHOT group to 6.7% in the N-SHOT group.

 Second, the ‘isolated islands stroke hotline system(I-SHOT)’, with which physicians in RIHs participate in cooperation with N-SHOT, was started in 2017. After I-SHOT was introduced, the number of patients treated with the drip and ship method using teleradiology and 24-h helicopter transportation increased from 20(2010-2016)to 29 cases in 2017-2018. Additionally, new information and communication technology(ICT)using smart devices was introduced into the teleradiology system for task support.

 Third, on behalf of stroke physicians, nurse practitioners(NP)helped bedridden patients who had been delivered from RIHs and who had received acute treatment, and returned to their islands by helicopter or airplane as transitions of care.

 N-SHOT is smoothly operated by each hospital department without reducing the quality of the stroke hotline. It has contributed to an increase in rt-PA and mechanical thrombectomy cases;I-SHOT has had the same effect. Task-shifting and task support with N- & I-SHOT, the smooth transfer system by NP, and the new ICT are considered to be useful for reducing the overall burden of stroke physicians.

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