Goldshire Hospital

Memorandum
November 10, 2016
To: Dr. Robert Goldshire
From: Kimberly Curtis, Project Manager
Carmen Acosta, Materials Coordinator
Shawn Massingill, Research Analyst
Timothy Miner, Research Analyst
Subject: Progress Report for the Mobile Stroke Unit

Purpose
This report is to inform Dr. Goldshire of the progress of our research regarding
the pros and cons of having an MSU available to our Emergency Service
Department.

Introduction
Our research is currently on schedule. As of November 10, 2016, Dr. Robert
Goldshire approved our proposal to research the viability of purchasing a
Mobile Stroke Unit for use by Goldshire Hospital.

123 LITTLE ST., F

ORT, WORTH,

TX 76028
T 817-555-5555 U GOLDSHIREHOSPITAL.ORG

Research Progress
Task 1. Produce an initial cost analysis of an MSU
The MSU is a $1.0 million Emergency Vehicle (MSU brings). The MSU will
require a Critical Care Nurse, a CT Tech, a Paramedic, an EMT, and sometimes a
Neurologist will be on board (Mobile Stroke). The MSU will also be equipped
with telecommunication services, this will allow the neurologist to review the
patients scans, labs, and medications while on route to the hospital.
Task 2. Determine the average length of Hospital stay, including
rehabilitation time, and the cost associated with stroke patients
A Stroke or Cerebrovascular accident is difficult to treat as there is little time
between onset and permanent effects. Once treatment is complete,
rehabilitation starts and can be lifelong or shorter than the stroke itself.
Starting at the hospital the average stay of an Ischemic stroke patient is around
3-6 days, but may be longer if needed (learning). When a patient is discharged
from the hospital after a stroke, he/she may need round the clock care and
rehabilitation. This can average an estimated cost of $90,981 per year (Taylor).

Future Task
Task 3. Acquire an understanding of how the unit works and the
personnel typically required for its use
Currently, we are considering the Cleveland Clinics research on their trial of
the Mobile Stroke Unit. According to the Cleveland Clinic the goal is to shorten
the time between the onset of stroke like symptoms and the delivery of
thrombolytic drugs (Mobile Stroke Unit). As stated in task 1 the unit is
comprised of a paramedic, a critical care nurse, a CT technologist, and an EMS
driver. Further review of medical articles is needed to fully provided a better
understanding of this unit.

Task 4. Identify positive and negative trends and outcomes

associated with MSUs
We have found, when attempting to provide a balanced perspective regarding
advantages and challenges other Hospitals may have faced while utilizing an
MSU, there is limited data available. Currently, there are fewer than three such
units in use in the U.S.. Currently, there does not appear to be negative reports
regarding use of the unit, therefore, this task may need to be restructured to
showcase more advantages than challenges. Should we acquire any new
adverse reports, we will return to the original plan and include that data. As
for now, the unit appears to be a true asset to the Cleveland and Houston
areas.
Per initial survey, there is a dramatic decrease in call-to-therapy time (initial
911 call and actual treatment initiation), which translates to better patient
outcomes. The current gold standard of Tissue Plasminogen Activator (tPA)
medication administration in <3 hours has been dramatically reduced to
approximately 35 minutes for initiation of the life-saving medications used to
treat acute Ischemic Hemorrhagic Stroke (Fassbender, K. et al). This is
promising news and we will continue to collect more data.
Task 5. Analysis of data and present findings and recommendations
We would prepare a formal document for dissemination to the Board of
Directors and upload the same to a Wiki to allow for current employees to
review and advise. Revisions would be considered and included where
appropriate and the final document to be presented to the CEO, the Hospital
Sponsoring Physicains, and interested parties. We will present our report on
November 28, 2016.

Schedule
Date of Tasks

Task
Task 1:
Produce an
initial cost
analysis of a
MSU
Task 2:
Average
length of
Hospital stay
Task 3: How
the unit works
and the
personnel
Task 4: Out
comes
associated
with MSU
care
Task 5:
Prepare
Report
November

11

15

17

22

Works Cited
Fassbender, Klaus, and Walter Silke. Mobile Stroke Unit for Hyperacute
Stroke treatment. N.p., 1 June 2003. Web. 15 Nov. 2016
Learning about Your Health. N.p., 6 Oct. 2016. Web. 15 Nov. 2016.
Mobile Stroke Treatment Unit. UCHealth, n.d. Web. 15 Nov. 2016.
Mobile Stroke Unit. Cleveland Clinic, 5 Aug. 2014. Web. 15 Nov 2016.
Mobile Stroke Units Bring You Quicker, Lifesaving Treatment. Cleveland
Clinic, 29 Oct. 2014. Web. 15 Nov. 2016.
Taylor, Thomas, Patricia Davis, James Torner, Jay Meyer, and Mark Jocobson.
Lifetime Cost of Stroke in the United States. N.p., 1 Sept. 1996.
Web. 15 Nov. 2016.