Redefining Stroke Response Time with Sevaro OneCall™

Telestroke Response in the Emergency Room: Connecting with the Vascular Neurologist

Introduction: Stroke Demands Faster Action

Stroke is the fifth leading cause of death in the United States and the leading cause of serious long-term disability. In some states like Illinois, it ranks as high as the third. While public education campaigns from organizations like the American Heart Association have raised awareness, stroke rates continue to rise—especially in younger adults. In fact, stroke incidence among patients aged 18 to 45 has increased by over 40% in recent decades.

When stroke prevention fails, the best defense is early symptom recognition and immediate treatment. That’s the foundation of a strong Telestroke program. But even well-designed emergency workflows can break down if there’s no efficient way to connect with a vascular neurologist. In many hospitals, neurologists are not available onsite, and the emergency department may struggle to distinguish stroke from other conditions in a high-pressure environment.

Telemedicine helps bridge this gap, but there’s still no universal standard for how quickly a hospital should be able to connect to a teleneurologist. This delay can cost lives—and brain function.

Why Telestroke Connection Time Matters

Most stroke care guidelines focus on what to do after the neurologist joins the consult. Far fewer guidelines address how quickly that neurologist should be brought into the conversation.

Some organizations, like the American Telemedicine Association, offer vague guidance, suggesting turnaround time requirements may be recommended. Others, like the DVN-GL, suggest a neurologist should be available within 20 minutes of stroke alert initiation. But in a world where 1.9 million neurons are lost each minute during an ischemic stroke, even 20 minutes is too long.

The challenge isn’t just diagnosis—it’s access. And the first barrier is connecting the emergency care team to the right specialist, fast.

Common Telestroke Connection Methods

Hospitals use several methods to route stroke consults to teleneurologists. Each method has strengths—but also critical limitations.

Telehealth Platforms integrate call and notification alerts as part of their comprehensive package. While exact workflows differ, most platforms allow onsite staff to request a consult and then are placed in a “waiting room” until the provider joins the meeting.

Healthcare Communication Apps give any healthcare worker the ability to create teams and establish communication with other team members about a specific patient. These Apps allow team members from multiple touchpoints along the patient journey to communicate effectively.

The connection type chosen typically rests on the workflow and resources of the hub site that is providing the Telestroke service. There are three different options for the hub site.

  • Option 1. A health system is providing Telestroke services from a larger hospital to its smaller and less-resourced sister hospitals.
  • Option 2. A health system is providing the service to smaller, regional hospitals that are not within the hospital system.
  • Option 3. A hospital has contracted with an outside vendor that provides Telestroke services as a standalone program or to augment their own neurological services.

A call center is typically used to help triage the most acute cases and collect data when many hospitals are linked to a sizable number of vascular neurologists. Call centers collect data and start manual processes however, they are typically for the benefit of the hub site, not the patient site. Utilizing a call center can be associated with multiple limitations; delay in treatment time as the team onsite and the teleneurologist must be connected through a third party, miscommunication of information resulting in confusion and delays, human-error leading to a missed stroke code.

Telehealth platforms exist to incorporate all facets of patient care into one application. While video and audio are paramount to creating a patient/physician relationship, these platforms incorporate additional features such as alerts and notifications to create a comprehensive package. Typically, a direct link or a virtual waiting room is created and when both parties are ready the consultation may begin. Coordination of the provider and the site relies on the teleneurologist to be available when the alert comes through. Many technologies allow for a backup provider to step in when the on-call teleneurologist is busy.

Healthcare Communication apps allow healthcare teams to harness the power of cell phones, and tablets to quickly assemble a team of professionals to assist in patient care. While in the field an EMS team member can identify and alert a predetermined team member of the impending stroke arrival. These communication apps allow for effective communication, documentation, and timestamp validation without the need to purchase disparate hardware. However, there is an assumption that all members of the care team will be able to assist when called upon for this app to work appropriately. This can be especially complicated if the hospital uses a Telestroke vendor to staff their vascular neurologists as the vendor will be less likely to use a technology for only one or two customers.

A More Intelligent Telestroke Model

Traditional telestroke programs often rely on large pools of neurologists covering dozens of hospitals. Scheduling is complex, and coverage gaps are common. Call centers and waiting rooms slow everything down.

Sevaro OneCall™, part of Synapse AI, was created to solve this problem. It’s a streamlined teleneurology connection system that allows hospital teams to speak directly to the on-call neurologist within seconds—no call centers, no waiting rooms, and no intermediaries.

This system combines intelligent physician scheduling with automated call routing. When a stroke consult is needed, the request goes straight to the neurologist or is automatically routed to a backup if the primary is unavailable.

Hospitals using Sevaro OneCall can:

  • Connect with a teleneurologist in under 45 seconds

  • Make treatment decisions immediately with live physician input

  • Automatically route calls to backup providers when needed

  • Log time-sensitive stroke metrics for quality reporting

  • Bypass call centers and virtual waiting rooms entirely

Sevaro OneCall is available to:

  • Hospitals that run their own Telestroke program
  • Hospitals that serve other hospitals through a Telestroke network
  • Any Sevaro Telestroke and teleneurology customer.

 

Conclusion:

With today’s siloed yet sophisticated health system hospitals must invest in telehealth platforms and communication applications to create Telestroke programs that empower acute care staff to connect with vascular neurologists.

However, call centers can and should be replaced to cut down on redundant and expensive processes that delay communication and, in some instances, impede communication.

Sevaro OneCall is one example of using a technology to replace this traditional function in Telestroke response. A connection with the vascular neurologist within 45 seconds should be considered as the new standard in stroke response.

When this type of response time can be replicated repeatedly it allows all hospitals, regardless of size and resources, to treat ischemic stroke patients as fast as possible.

Ready to see what a partnership with Sevaro can do for your hospital?

Schedule a demo or give us a call today!

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    Eddie Vincent’s Journey Back: A Hospital Insider’s Tale

    A stroke survivor in a hospital bed, celebrating life with family after recieving care from Sevaro's telestroke team

    The Day That Changed Everything

    I’ll never forget the morning Eddie Vincent was brought into our hospital. I was working the floor in the ED when his partner, Sandy, rushed him through the doors.

    Eddie, a man known to many as a tough truck driver and an avid Harley rider, had faced a series of health crises that would challenge anyone’s strength. After surviving a heart attack and sepsis, he suffered a major stroke that resulted in expressive aphasia—leaving him unable to speak fluently. It was heartbreaking to see such a strong person rendered so vulnerable.

    The Rush Against Time

    The emergency team sprang into action as soon as Eddie arrived. Under the leadership of Dr. Ruchir Shah, Sevaro’s Director of Clinical Service Lines & Implementations, our stroke team administered t-PA, a clot-busting medication crucial for treating Eddie’s type of stroke. These moments were fraught with tension, not just because of the medical risks associated with the treatment, but also because of the uncertainty and fear evident in Sandy’s eyes. She was worried about the potential side effects of the treatment, but she trusted our team to do everything we could for Eddie.

    Challenges Along the Stroke Recovery Path

    Recovery was not straightforward for Eddie. Initially, he resisted further testing, overwhelmed by the implications of his condition. His concern wasn’t just for his health; he was terrified of the financial burden his hospitalization might place on Sandy. He felt trapped by circumstances, fearing that his inability to work and the potential medical bills could ruin the life they had built together.

    Moments of Hope

    Despite the darkness of those days, there were moments of incredible hope and tenderness. One day, Sandy came to visit wearing her wedding band. Without saying a word—a communication beyond words—she showed Eddie her commitment and love.

    That gesture seemed to turn a light on inside Eddie. Later, when he slightly lifted his finger to touch her ring and then smiled for the first time since the stroke, everyone in the room felt a wave of emotion.

    Recovery and Resilience

    The road to recovery was paved with the support of many. From our dedicated hospital staff to the social workers and speech therapists, everyone pulled together to help Eddie find his way back to speaking.

    His family, friends, and even strangers contributed to his recovery. I watched as his stepson and Sandy’s daughter spent countless hours helping him regain his speech, transforming a daunting challenge into a family bonding activity.

    A New Chapter

    On a Valentine’s Day, just a few months later, Eddie managed to whisper “I love you” and “I do” to Sandy. It was a profound affirmation of their journey together, a moment of joy amid the struggles.

    Continuing the Fight

    Nearly five years have passed since that fateful stroke, and while Eddie’s life has irrevocably changed, his spirit remains unbroken.

    He and Sandy cherish each day, grounded in love, faith, hope, and healing. Sandy has become a vocal advocate for stroke awareness, encouraging others to stay positive and engaged in the face of adversity.

    Eddie’s story isn’t just about survival; it’s about finding strength and love in the hardest of times. As someone who witnessed his journey from the front lines, I can say it’s a profound reminder of the resilience of the human spirit and the power of dedicated medical care.

    We in the healthcare community continue to learn from patients like Eddie, who teach us that every day is a gift worth fighting for.

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      Six Highlights from the International Stroke Conference 2022

      May 26, 2022

      Six Highlights from the International Stroke Conference 2022

      The American Heart and American Stroke Association hosted the annual International Stroke Conference in New Orleans in February. Over 5000 participants attended the event, both in-person and virtually.

      There was a palpable excitement in the air as many of us were attending an in-person conference for the first time in over two years, reuniting with old colleagues and networking with new connections. The science presented truly matched the excitement. Without further ado, we highlight six key takeaways!

      • Cerebral Venous Thrombosis – An update and the ACTION – CVT
      • Artificial Intelligence and Technology
      • RESCUE – JAPAN
      • Mobile Stroke Units
      • Robotic TCDs for shunt detection
      • CHOICE – EVT w/ AI TPA

      CVST update and trial presentation ACTION – CVST

      Dr. Lily Zhou from Stanford presented an excellent overview of the evolving epidemiology and pathophysiology of cerebral venous thrombosis, showing the increasing incidence of CVTs over time.

      Also highlighting that many patients are diagnosed in the context of co-morbid trauma, infection, inflammatory disease, cancer, and also in the setting of COVID infection and vaccination.

      Dr. Thalia Field discussed medical management in CVST, noting that over half of patients will have some degree of recanalization after only one week of anticoagulation and over 10% of patients will experience a seizure.

      Lastly, Dr. Violiza Inoa described imaging modalities including MRI being 80% sensitive and 95% specific for diagnosis. In addition, she described the limited but important role of endovascular therapy in some patients with CVST.

      Artificial Intelligence in stroke

      Physicians and companies from across the country highlighted the important and growing role of artificial intelligence in stroke care access, evaluation, and delivery. From telestroke software to radiology tools to aiding in imaging evaluation,companies including RAPID-AI, Viz.AI and doc.AI displayed their innovative software platforms that deliver imaging results to stroke care teams instantly, leading to more rapid decision-making.

      Dr. Ameer Hassan, current president of the Society of Vascular and Interventional Neurology presented a historical summary of artificial intelligence and technology in stroke care. Dr. Hassan described that the tenets of artificial intelligence can be seen throughout modern history. In terms of stroke, centers across the country are utilizing deep neural networks to improve recognition of large vessel occlusion.

      Dr. Hassan described how this technology has greatly improved his own center’s ability to rapidly triage patient transfers from their large catchment area.

      In addition, the platforms act as a one point touch down place for communication for possible clinical trial enrollment and communication on a patient’s clinical status. This is highlighted with early detection, rapid triage and synchronized care coordination. “Green is go, Red is dead,” in reference to the perfusion mapping that can even be sent to your smartwatch. Using this tool they showed the time and economic savings by implementing stroke software.

      RESCUE – JAPAN

      Previous thrombectomy trials guided the delivery of mechanical thrombectomy past the 6 hours of symptoms onset to patients with minimal “core” or minimal completed stroke at time of intervention.

      Current guidelines support thrombectomy as a safe and highly effective therapy in select patient populations. New emerging data supports possibly expanding eligibility and including patients who present with a large ischemic core.

      A group out of Japan led by Dr. Shinichi Yoshimura concluded that “Patients with large cerebral infarctions had better functional outcomes with endovascular therapy than with medical care alone.” The study presented was met with a standing ovation by the crowd in New Orleans!

      The primary outcome was mRS of 0 to 3 at ninety days. Notably, it also showed a trend to less craniectomies. For the safety outcomes, the intervention arm did not show a significant difference in symptomatic intracranial hemorrhage. This study gives more support for expanding the scope of patients who may benefit from established interventions.

      Mobile Stroke Units

      Mobile stroke units have been highlighted in the literature multiple times in recent years, including the paper in NEJM, led by Dr. James Grotta https://www.nejm.org/doi/full/10.1056/NEJMoa2103879 showing improved mRS at 90 days when patients were treated by a mobile stroke unit compared to standard EMS.

      At ISC22, a team from UTHealth led by Dr. Rajan analyzed the economic and clinical impact of mobile stroke units. Using primary end point measures of quality-of-life, the team presented their prospective multicenter study, demonstrating improved quality-adjusted life years in all patients. The study showed early neurologic recovery and functional independence was more frequently achieved in the MSU group compared to EMS. This study adds to the growing body of literature with data supporting both clinical and economic advantages of mobile stroke units.

      Transcranial Doppler (TCD) for shunt detection, BUBL study

      The role of imaging and technology in stroke evaluation continues to grow. There were multiple abstracts regarding the utility of TCD in patients with neurovascular disease, highlighting the importance of this low-cost, safe technology. At the late breaking science session, Dr. Mark Rubin presented the results of the BUBL study showing improvement in right-to-left shunt detection using robotic assisted transcranial doppler compared to transthoracic echo. The study evaluated 129 patients for right-to-left shunt. A shunt was detected by the robotic assisted TCD in 62% of patients, compared to only 19.4% using echocardiogram (P<0.001). This study emphasizes that TCD technology, with the assistance of the robotic device, is safe and effective in detecting right-to-left shunt, even without a skilled technician.

      CHOICE – EVT w/ AI TPA

      The CHOICE-EVT group led by Dr. Chamorro evaluated the use of intra-arterial alteplase after successful thrombectomy. The group discussed in their JAMA neurology publication that the planning of their trial was based on “postulated that thrombi persist within the microcirculation in patients with normal or nearly normal cerebral angiograms at the end of thrombectomy, and it was hypothesized that these smaller thrombi would be more suitable to dissolve than more proximal thrombi because the efficacy of thrombolysis is related to the extent of clot burden.”

      The study aimed at improving the reperfusion in the microvascular bed. The design was double-blind, placebo controlled, and results of the intervention arm of IA alteplase showed improved outcomes in mRS at 90 days and no increased risk of intracranial hemorrhage.

      References:

      • RESCUE Japan

      Yoshimura S, Sakai N, Yamagami H, et al. Endovascular therapy for acute stroke with a large ischemic region. N Engl J Med. Published online February 9, 2022.

      • Mobile Stroke Units

      Grotta JC, Yamal JM, Parker SA, et al. Prospective, multicenter, controlled trial of mobile stroke units. N Engl J Med. 2021;385(11):971-981.

      • ACTION-CVST

      Yaghi S, Shu L, Bakradze E, et al. Direct oral anticoagulants versus warfarin in the treatment of cerebral venous thrombosis (Action-cvt): a multicenter international study. Stroke. 2022;53(3):728-738.

      • CHOICE-EVT

      Renú A, Millán M, San Román L, et al. Effect of intra-arterial alteplase vs placebo following successful thrombectomy on functional outcomes in patients with large vessel occlusion acute ischemic stroke: the choice randomized clinical trial. JAMA. 2022;327(9):826-835.

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