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Helistop Will Allow Larger Community to Benefit From Overlook's Expertise, Medical Director Says

John J. Halperin, MD, says Overlook's "outcomes are unsurpassed by any stroke center in the region."

Dear Editor: 

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. 

Sincerely,  
John J. Halperin, MD
Chair, Neurosciences, Atlantic Health System
Medical Director, Atlantic Neuroscience Institute
Professor of Neurology & Medicine, Mount Sinai School of Medicine
Michael S. Dzikowski February 12, 2014 at 01:04 PM
Before attempting to minimize the other fine NJ stroke centers Dr. Halperin cites in his recent letter campaign, he should more accurately disclose “Castle Connoly’s” hospital report available on his Atlantic Health site. “Inside Jersey’s 2013 Top Hospitals”, ranked MORRISTOWN #1, not Overlook! St. Barnabas was ranked #2, Overlook #3, Hackensack #4 and Valley Hospital #5 for “Treatment of STROKES”..... In another category, “Treatment of NEUROLOGICAL DISORDERS”, Castle Connoly ranked ST. BARNABAS #1, MORRISTOWN #2, Overlook #3, Hackensack #4, and Valley Hospital #5. It should be mentioned that Morristown was also ranked #2 in "Patients Highly Satisfied". Overlook tied for #8 in patient satisfaction. In the "Patients' Room & Bathroom Kept Clean" category, Morristown ranked #5. Overlook was not ranked in the Top 10 (nor Top 20 including ties)! Maybe, Overlook’s management should re-focus on more fundamental, core services before beating its chest at the expense of other stroke care medical centers?.... http://www.castleconnolly.com/insidehospitals/results2013/
Michael S. Dzikowski February 12, 2014 at 01:18 PM
Atlantic Health claims, "As New Jersey’s leading provider of Neuroscience care, Overlook “houses” the Atlantic Neuroscience Institute (ANI), which serves as the hub for the New Jersey Stroke Network, a group of hospitals treating 40% of the state’s stroke patients". But, ANI is really a "sum of the parts institute". It is an asset class composed of excellent, experienced physicians with specialized medical staffs, sophisticated tools and equipment and safe facilities. We are all very grateful. However, ANI is NOT simply a Summit LOCATION! ANI's “40% claim” counts the TOTALITY of ALL its "hub & spoke" revenue sharing, "introducing client/hospital business relationships” which it hopes to grow. ANI includes Overlook, its sister affiliates, Newton Medical Center, and of course, Atlantic Health’s premier, #1 NJ TOP 10 STROKE FACILITY, MORRISTOWN MEDICAL CENTER (per Castle Connolly Medical, Ltd.). Combining three Atlantic Health hospitals’ volume is how Dr. Halperin misleads us on “Overlook’s” very high stroke patient volume. Remember, Morristown has always had access to the SAME neurosurgeons as Overlook (note their many Neurologists’ offices in Morristown) but, Overlook does not want to highlight ANI’s already approved Trauma Center Helipad there! Dr. Halperin is the Medical Director of the TOTAL ANI group! Top competitor, St. Barnabas Medical Center is ranked the #2 Stroke Facility with a helipad; Overlook is ranked #3; Hackensack Medical Center is ranked #4 with a Trauma Center helipad; Robert Wood Johnson is #5, also a Level I Trauma Center with a helipad. The truth is, we are very fortunate to have NO SHORTAGE of care or helicopter service for "life threatening situations". In NJ we have 110 hospitals including 52 Primary Stroke Centers and 13 Comprehensive Stroke Centers for our 21 counties.... In 2008, the New Jersey Department of Health published a study of “New Jersey’s Risk Adjusted Acute Stroke Mortality Rate” for the period 2002-2005. To help evaluate experience, in 2005, the “Acute Stroke Volume” ranking was University Hospital (432) #1, Robert Wood Johnson (429) #2, JFK Medical Center (386) #3, Valley Hospital (369) #4, Overlook (356) #5, St. Barnabas (345) #6, St. Joseph’s (310) #7 (<300, Morristown’s volume was 241 and Newton 98). As for Dr. Halperin’s claims of ”unsurpassed outcomes”, the 2005 NJDOH Adjusted Mortality Rate rankings for acute stroke facilities with volumes ≥300 reflected: Jersey Shore Neptune at 6.3% #1; JFK Medical Center 7.1% #2; St. Barnabas & Hackensack 8.9%, tied for #3; Robert Wood Johnson 9.9% #4; University Hospital 10.5% #5; Valley Hospital 10.7% #6; Atlantic Health’s ANI (combined Overlook 10.9%, Morristown 12.3% and Newton 6.6% volume weighted mortality rate = ) 10.8% ranked #7; St. Joseph’s Patterson 12.2% #8. To compare and put these stroke mortality rates in context, NJDOH reported the U.S. average mortality rate was 10.6% and the New Jersey average was better, at 10.0%. http://www.state.nj.us/health/healthcarequality/stroke/documents/stroke_mortality_nj02-05.pdf
Michael S. Dzikowski March 20, 2014 at 03:26 PM
3/18/2014 The NY Daily News and, ABC News report that two people died (pilot & photographer) and another person was seriously injured on the ground after a Seattle news Eurocopter attempted a ROOFTOP take-off. The helicopter plummeted from the rooftop Tuesday morning, crashing into two cars on Seattle’s Broad Street, exploding in a massive fireball just fifty feet from the city’s distinctive “Space Needle”... Seattle resident, Richard Newman, 38, pulled himself from his car after suffering burns on 20% of his body. His condition has been upgraded from critical to serious condition. While mystery still surrounds the cause of the helicopter crash, there were reports of it appearing to malfunction moments after lift-off, quickly becoming engulfed in flames. A “Helihub.com” search today (3/20/2014) for all 2014 helicopter accidents (globally) now reveals 102 accidents Year-to-Date. Of these, 23% involved one or more on-board and/or on-the-ground fatalities, totaling 59 dead.... Atlantic Health’s appeal to the NJDOT for an additional dangerous, rooftop helipad should be emphatically denied. When are we to hear of NJDOT’s final decision after Summit and the NJ Court have both denied the dangerous helipad plan? http://abcnews.go.com/US/helicopter-crashes-seattle-space-needle/story?id=22954771 http://www.nydailynews.com/news/national/news-helicopter-involved-fiery-crash-feet-seattle-space-needle-article-1.1725382

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