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Letters to the Editor
Helipad Will Further Extend The Benefit of Overlook's Expertise
I write to express my strong support for a helistop at Overlook Medical Center.
Much of the recent commentary about the plan for a helistop at Overlook Medical Center in Summit has focused on the notion that many equivalent hospitals in the region serve stroke patients, and thus a helistop is not required at Overlook. The question has been raised, why can’t stroke patients just be brought to St. Barnabas Medical Center in Livingston, Robert Wood Johnson University Hospital in New Brunswick, University Hospital in Newark, JFK Medical Center in Edison, etc. The answer to this is straightforward. First, is that all stroke centers are not equal. Overlook Medical Center is simply the most experienced in northern New Jersey; most important, our outcomes are unsurpassed by any stroke center in the region. Other New Jersey hospitals frequently ask Overlook to share this expertise, transferring their most severe stroke patients to us. A helistop will enable Overlook to significantly enhance these patients’ outcomes by minimizing transport time and allowing more rapid treatment.
In managing all types of stroke, experience matters. As with most medical care the more patients with a particular diagnosis treated at a particular hospital, the better the outcomes. In the three years following the denial of Overlook’s helistop application, we treated 1,643 patients with stroke – more than any of these other hospitals. One of the best measures of the ability of a hospital and its staff to manage stroke patients is the percentage of patients who receive the clot dissolving drug tPA. During this three year period we have treated 10% of all stroke patients presenting to our hospital – a rate roughly double that at Hackensack or JFK and 20% greater than that at University Hospital in Newark. The time it takes to administer this drug is under 60 minutes in about 80% of patients – a statistic that places us among the top performing hospitals in the United States. Because we do this so well, Overlook leads the New Jersey Stroke Network, a group of approximately 20 hospitals, and works with numerous hospitals around the state to help them improve their processes.
But these are not the patients who are transferred to Overlook Medical Center from other hospitals – or would be transferred by helicopter for more advanced care. Patients are transferred when the blocked arteries responsible for their strokes do not clear with intravenous tPA, or if the patient is medically ineligible to receive this drug. In a small proportion of this subgroup, advanced interventions can be used to physically enter the blocked artery and remove the clot – a procedure with which we are the most experienced in the region. With this group of patients, as with those receiving intravenous tPA, one of the most important determinants of treatment success is time. With every additional minute that the brain is deprived of blood an estimated 2,000,000 additional nerve cells die. Treatment delay translates directly to increased likelihood of disability - such as paralysis, loss of language or the loss of the ability to take care of one’s basic needs - or death.
Finally, there are the sickest of all stroke patients, those with ruptured brain aneurysms and other brain bleeds. For these patients, too, a critical determinant of outcome is the advanced skill and experience of the team – physicians, nurses, technicians, therapists, etc. – who will take care of them.
Several national organizations, as well as the State of New Jersey, have created the designation ‘Comprehensive Stroke Center,’ primarily to designate hospitals capable of treating such terribly sick patients. One of the key criteria for this designation is that the hospital treats at least 25 such patients annually. Currently, only eight New Jersey hospitals meet this threshold. Experts in the field agree that even among hospitals performing this minimum number, the greater the team’s experience, the better the outcomes. During the same three year period, Overlook Medical Center treated 370 patients with brain aneurysms – about 20% of all NJ residents with this diagnosis, and about five times the number treated at JFK, four times the number at Hackensack or St. Barnabas, three times the number at Robert Wood Johnson or University Hospital. This number not only directly translates to a more experienced and expert team, but also reflects the confidence of New Jersey’s many other medical centers, who transfer their patients to us for care. As a result, our outcomes with such patients are unsurpassed by any other institution in the region – whether measured by the ‘survival score’ in U.S. News & World Report® or any of a number of other publicly reported analyses.
In sum, the objective data demonstrate that Overlook Medical Center is the region’s leading center for treatment of stroke. The helistop will enable Overlook Medical Center to further extend the benefit of its expertise to the residents of our region and larger community.
John J. Halperin, MD
Chair, Neurosciences, Atlantic Health System
Medical Director, Atlantic Neuroscience Institute
Professor of Neurology & Medicine, Mount Sinai School of Medicine