Background: Our Neurovascular Advanced Practice Clinician (APC) program is a collaboration between Neurointerventional Radiology (NIR) and the Vascular Neurology Inpatient Service (Ward). Members of this team (nurse practitioners and physician assistants) provide 24/7 coverage and rotate on both services. We will describe the roles of the APC throughout the acute stroke process, on the ward, and in NIR. Typically, one APC is on NIR and one on the ward during the day, and one covering both NIR and ward at night.
Summary: An APC responds to all Code Strokes and works with the neurology resident to facilitate acute therapy. They review imaging in real time and confirm findings with the radiologist. When indicated, the APC works with ED and neurology staff to facilitate rapid administration of tPA. For Large Vessel Occlusion (LVO) stroke, the APC discusses the case with the NIR attending and facilitates prompt transfer to the NIR suite. Once in the suite, the APC assists the attending performing the procedure. For after hours cases, they ready the suite for neurointerventional team arrival. Post procedure, the APC assists in patient transfer to the stroke unit. In NIR, The APCs handle pre- and post-procedure documentation, orders, and participate as assistants. The APCs routinely obtain arterial access for endovascular procedures and perform closure of the arteriotomy. The APCs also follow inpatients after a procedure, write daily progress notes and are responsible for the care of patients admitted to the NIR service. On the ward, the APCs manage their own patients, present at rounds and develop a plan in conjunction with the attending physician. Their role includes obtaining detailed history and physical exam, ordering medications, ordering and interpreting diagnostic tests. They write daily progress notes and generate discharge summaries.
Conclusion: Our Neurovascular APC program is a unique collaboration between service lines caring for the acute stroke patient. The APCs are an invaluable resource in all facets of the care of these patients. This novel design allows APCs to participate in the stroke patient’s management across the continuum of hospital care from ED arrival to hospital discharge.