Building a Comprehensive Stroke Center
Author: Sharon Webb, MD
I have wanted to be a neurosurgeon since I was 16. Neurotrauma was what I thought I wanted to do, much to the dismay of my chairman who always said I was wasting my talent not going into cerebrovascular neurosurgery. However, I stuck to my guns and I did a neurotrauma and critical care fellowship with Dr. Shelly Timmons. My heart always longed to return to my home state of South Carolina, so after my training ended I returned and joined the busiest Level 1 trauma center in the state.
As fate would have it, I ended up doing all the open cerebrovascular cases for the practice. Then we lost our endovascular person, so I did an endovascular fellowship in Buffalo, NY and ended up a dual-trained cerebrovascular neurosurgeon after all. Since then, I have built two endovascular programs and two Comprehensive Stroke Centers (CSC), which were the second and fifth CSCs in the state. It turned out in the end that stroke and cerebrovascular disease was my love and passion.
“In order to accept who you are, you cannot hate the experiences that shaped you”
- Andrew Dykstra
Building a CSC is very challenging from a process, resource, and administrative level. It takes commitment from every department, every floor, every nurse, every practitioner and every physician—from the moment a patient arrives in the ED until they are discharged from rehab. To do it well, you need the complete backing from hospital administration—to hire FTEs, purchase technology and create/build infrastructure.
I spent my entire career at academic, level 1 trauma centers until I took my current position as the Director of the Bon Secours Saint Francis Cerebrovascular and Stoke Center at a Catholic community hospital in Greenville, SC. While this move felt absolutely right, it was one of the hardest decisions I ever had to make. I knew my team and I would be starting over, and there would be even greater challenges in a community hospital. A former fellowship director, Elad Levy, pointed out to me that community hospitals are able to focus on service lines they want to invest in, such as cerebrovascular and stroke, allowing for more autonomy and quicker growth than larger, corporate hospital systems. He was absolutely right.
I started this position November 5, 2018 and as I write this piece, our CSC certification visit is only a few weeks away. The new GE biplane suite is almost complete. The amount of dedication to getting the processes in place, educating the entire hospital, and obtaining the resources we needed to make this happen is nothing short of a miracle. It is a testament to what can be done when a hospital and a community see the need for a service line and program and work together to make it happen.
There are definitely challenges to a community hospital setting. I quickly learned we did not have a helipad or a working ED radio – things I had taken for granted having always been in a trauma center. So some of the basic infrastructure I was used to was not in place. However, this allowed us to work closely with the EMS and air transport companies to develop a process for patient transfers via helicopters and to forge stronger relationships, working side by side to help build this much-needed program from the ground up. Now we have a new ED radio, and the construction for the helipad and new ED building is slated to begin in January 2020. There are many challenges when starting a program, but it is exciting to see everyone’s hard work come to fruition, especially when you are surrounded by dedicated, hardworking people who put patient care first.