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Time Is Brain

Dr. Irene Katzan was about to step into exam room S8-211 to see the next patient on her morning's schedule, a 72-year-old woman who had experienced a transient ischemic attack (TIA) nine days before, when the pager in the right hip pocket of her white clinician's smock vibrated. She read the message, MOBILE STROKE UNIT EN ROUTE 10 MINUTES, and clipped the device onto her coat.

As a staff physician in Cleveland Clinic's Neurological Institute, Dr. Katzan specializes in cerebrovascular disease and secondary stroke prevention (the word prevention occupies a prominent position in her clinical philosophy). Even though the distinction between a stroke (the presence of focal neurological deficits that last for more than 24 hours) and a TIA (deficit symptoms lasting less than 24 hours)1 may, in recent years, have begun losing some of its importance given how effective the same preventative approaches have become for treating either condition, to Dr. Katzan, preventing a stroke is clearly the preferred approach for minimizing the damage it can inflict. And preventing damage was also the reason she kept a special pager in her right hip pocket.

Nicknamed the "clot" pager, it only went off for one reason: someone was in the process of having a stroke. In about 10 minutes, she would be treating that patient, wherever the patient happened to be in a surrounding area of about 100 square miles.

Since her next patient was already roomed, Dr. Katzan asked her physician's assistant (PA) to go ahead and start taking vitals while she excused herself and walked down a hall in Cleveland Clinic's second oldest building toward a room that contained some of the organization's newest equipment. As she did, her clot pager vibrated a second time, and the display read, ON SCENE DROP ORDERS, followed by an electronic medical record number (eMRN).

Leaving the lights dim, Dr. Katzan sat down at a computer workstation that had two very large high-definition flat-screen monitors positioned side by side that could either display information independently or be quickly configured to work as one big screen. Logging in to the MyPractice electronic health record system, she entered the eMRN she had been sent and found that the 66-year-old male patient she was about to treat was already established, meaning he had received care from a Cleveland Clinic provider in the past. (One convenient feature of the Mobile Stroke Treatment Unit program, which had been functional for almost one year, was that even if the patient had been new to Cleveland Clinic, there was a process in place through which that new patient would have been registered, on the fly, in real time.)

Though, on the outside, the Mobile Stroke Treatment Unit may look like an ordinary ambulance, on the inside it is actually a million-dollar, specially designed rolling stroke-specific emergency department equipped with a portable computerized tomography ...

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