Welcome to NeuroDox

A virtual support model for decision support and resource management for complex neurologic care. Live Chat enables a simple text message gateway into a team of online clinical support team members. These can be nurses, physicians, allied health professionals, care managers or other care coordinators who have access to a special database that updates which critical resources are available at any point in time. They use simple, readily accessible and highly affordable tools to easily facilitate virtual video consultations with other clinicians in real time, to share screens for easy viewing of records together, and to coordinate access to more specialized expertise when, how and where it is needed.  Your thoughts, ideas, suggestions and comments?…enter on bottom of this page!

Maryland Neuroscience Clinicians…as an extension of the MIEMSS QIC work on complex stroke care, we can being the pilot use of this platform.  The first survey has already been sent out to all QIC members and results received by the QIC team.  A database of resources is being accumulated and can be made accessible. We could then move onto the operational phase of supporting busy clinicians all over the state, independent of any particular institution, with a standard process of Decision-Support in real time. This could support initial efforts at a state-wide triage process to help reduce log-jams from Emergency Departments or even clinicians offices to neurocritical care and other rapid response expertise needed to advance acute stroke care management.

How can this process work?….proposed phase one model, with Maryland as a working pilot

Each hospital or provider organization interested in solving this problem is both a “requestor and a provider” of support.

If there are 25 hospitals involved in acute stroke, for example, each might contribute 8 hours a week of a “nurse triage support person” so that between the entire state there would always be ONE online text chat support “operator” 7-24-365.

All interested nurses would be trained in a core set of easy-to-use, inexpensive and highly portable “tools” to facilitate anything from email/phone/page/text notification of other experts, to shared online video consultations independent of any expensive technology…to screen sharing meetings where two clinicians can connect to view each other’s records/systems/radiology images and collaborate with the nurse’s assistance.

A shared online database is securely accessible to a core team member from each participating organization, in which they can post any known on-call availability, expert resources known to be available at their hospital/facility, easily update overall bed availability, etc

A central case tracking tool exists to enable all participating nurse support team members to know the status of all active cases or situations

All clinician experts (or their administrative assistants) can post into this database their own areas of interest, the best ways to reach them if needed either routinely or urgently, when they tend to be most accessible, and options for communications if not available at any point in time.

THE END RESULT?

Without disrupting any existing smoothly functioning referral patterns, a layer now exists that enables any clinician anywhere in the state, at any point in time..to get quick access to a nurse triage support person, who can readily get them connected to the right expertise, in the most convenient manner, to get the best decisions made and reduce all the inefficiencies of getting patient X at point Y to expert Z and point G…and in the process to maximize the options to effectively manage patients where they are..while “holding the hands” of local resources through a system that takes ownership of that care regardless of where it occurs.

Examples of the problem to solve:

Patient in ER, CT scan shows bleed, neurosurgeon locally not accessible

Patient in an ICU and deteriorating, needs more complex neurologic support for possible intracranial pressure management

Patient given TPA but consideration of intra-arterial therapy, and not sure which interventionalists are really accessible and what the likelihood of a procedure being done even if patient is transferred

In each of these situations, before calling to find out where to send the patient, why not get an expert ONLINE to look at information together with the ED, or the ICU or a hospitalist on a regular floor unit of another location…and do some shared decision-making.  And at the same time someone else is looking around to see what options might exist for facilitate transfer IF that is needed.  At the same time a plan is put in place to have that same expert connect back to the requestor in an hour through facilitated consult, to get some followup on the condition and help manage where the patient currently is….in case the urgency or need changes.

We are a small but growing group of Neurological, Neurosurgical, Neuroradiologic and other subspecialty clinicians who work pragmatically online to help provide triage support, review information and collaborate on cases related to clinical neurosciences.  The intention is to open the gateways to anyone affiliated with any program to get expert assistance, facilitate referrals, connect people for virtual consultations, and share perspectives on important issues. All of our professionals, and their colleagues and clients..will be leveraging a set of tools from text messaging to virtual consultation rooms, screen-share web meetings, secure off-line messaging that incorporates “screen capture/comment/share” methods…whatever is most appropriate at the time. We are all about the clinical support, NOT the technology. The tools are merely enablers.  When better tools and services are accessible for any purpose, then we will all use and encourage those as well!  And of course we welcome others interested in participating as expert neurologists or support team members!