A Successful Case Study in Eastern Missouri

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

Hospital Background

Our partnering hospital is a community-based hospital that has grown to serve all of eastern Missouri.  It is a 99-bed acute care hospital that provides comprehensive health and wellness services to the residents of the tristate area. In June 2021, Sevaro began the partnership, providing service to expand and fulfill their mission by providing access to teleneurology care.

The hospital takes care of a variety of neurological patients. In 2020, they lost their inpatient neurology coverage, and were suddenly unable to meet the neurological needs of the patients in their community. There was an immediate gap in acute stroke care coverage as well as inpatient rounding.

The Process & Solution

Teleneurology is a branch of telemedicine that allows neurological experts to evaluate patients remotely through different technology, including the telephone and videoconferencing. Sevaro is a technology-driven telemedicine company. Our team includes neurologists, nurses, and technology experts who have worked in over 100 hospitals across the country. This has allowed the best practice and standards of care to be delivered with a collaborative, experienced team by integrating clinical necessities with the most up-to-date technology.

Sevaro works with hospitals to ensure specialized and personalized delivery to each partner based on their needs. Patients are treated on video by a board certified neurologist managing complex patients at community hospitals.  Whether the gap in care is acute neurologic emergencies, neuro critical care, or inpatient follow-up, Sevaro offers the needed neurological care.

In June 2021, Sevaro began providing emergent neurological coverage and inpatient non-emergent neurological coverage for our partner hospital in eastern Missouri. The initial estimation for neurological consults was 50 per month. The results since initiation of coverage has been dramatic and game-changing for the hospital.

The Result

Sevaro saw a total of 643 neurological patients in the past 6 months: 217 for emergent care, and 446 for non-emergent and rounding. The average number of consults increased 114.33% from the initial estimation.

During those 6 months, the hospital was able to retain 131 of these neurological patients and prevent transfer, which reduced their transfer rate by a whopping 36%.

The breakdown of diagnoses for the top 5 highest neurologic patients was as follows:

  • Acute Ischemic Stroke – 30.39%
  • Altered Mental Status – 23.84%
  • Seizure – 14.73%
  • Toxic Metabolic Encephalopathy – 8.18%
  • TIA – 5.84%

“What a difference this is making for the patients of our region.  I so appreciate Sevaro’s team and the value they bring.  I believe we are bridging healthcare gaps in Northeast Missouri.”

Process Improvement Coordinator, Sevaro Partner Hospital

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    How To Get Support Post-Stroke With Sevaro

    August 7, 2022

    A stroke is a life-changing event both for the patient and the family. Although teleneurology has led to major advances in the rapid treatment of strokes and significantly improved patient outcomes post stroke, there is still a significant amount of rehabilitation required. Stroke survivors need significant support on their journey to recovery, and Sevaro’s My Stroke Journey is an innovative program that can help every step of the way.

    What is My Stroke Journey?

    My Stroke Journey is a patient support group that helps people live with and manage the effects of a stroke and post stroke. The program was developed by Becky Toney, RN, BSN, SCRN, Susan Woolner, CPXP, and Pete Smith, who is a stroke survivor. Pete had a stroke at age 35, and he started My Stroke Journey to allow people to share their stories and learn from their experiences, ultimately helping stroke survivors through the long journey of recovery.

    “Surviving a stroke is one thing, and that’s a challenge in and of itself, but a real challenge for a lot of these patients is what happens afterward,” says Pete.

    It is a common misconception that being young and fit equates to being immune to acute illness. However, one of the most important things to know about strokes is that they do not discriminate. They affect people from all walks of life, regardless of age or fitness level.

    Due to this unfortunate reality, many stroke patients who live an active lifestyle are left with a jarring wake-up call. Many who have been through this experience feel a sense of confusion and fear, and often with feelings of depression and anxiety, which interfere with optimal recovery.

    Without a proper support system and realistic expectations regarding what is to come, it can be easy for stroke patients to lose hope.

    Pete’s goal for My Stroke Journey was not only to share his story but to help others find the support system they need to make it through their journey.

    “The fact that I can relate to them because I’ve experienced it immediately establishes a certain line of credibility, and then we get a chance to meet people where they are but really help them get to where they can be, and that’s the focus,” says Pete.

    Sevaro’s unique My Stroke Journey program is essential because it encourages people throughout the recovery process and shows them they are by no means alone in what they’re going through.

    Sevaro is renowned for its developments in teleneurology, but one of its primary passions is supporting patients through each stage of their stroke journey.

    Why is a Stroke Support Group Important?

    Having a stroke can be traumatic and devastating for patients as well as family members. Many people require significant physical, emotional, and financial support following a stroke. Some of the best ways to obtain information are through peer support groups led by real stroke survivors as they have unique knowledge and insights regarding the trauma and the experience of recovery. People can also feel isolated after a stroke, which has a detrimental effect on health, so joining a support group can significantly benefit these patients.

    Sevaro Helps You Through Your Unique Stroke Journey

    When someone is diagnosed with a stroke, their rehabilitation journey starts from the moment they enter the ER and are diagnosed. They will receive acute treatment and a rehabilitation program from therapists tailored to their needs. Each stroke affects each individual patient differently, too, so one person may have difficulty speaking, but someone else may only experience motor function deficits. When patients start on their rehabilitation journey, they will be invited to set a simple goal or two which will help them focus on recovery. For some survivors, the goal could be walking to the local diner again, while for others, it could be speaking to a friend or relative.

    The survivors in these support groups have real insight into the experience of having and recovering from a stroke. Joining a group helps people feel less isolated, and before long, individuals find themselves helping other patients with their acquired knowledge and experience.

    What Happens at My Stroke Journey Group Meetings

    Sevaro’s My Stroke Journey support program is a monthly group meeting for patients and caregivers. It is free for people to attend, and is supported by our clinical team. The group is led by Pete Smith, who shares his first-hand experiences with the members. The atmosphere is very welcoming, and people are invited to share their unique experiences, and also to talk about the physical and psychological effects of post stroke. Typically after the meeting, patients feel motivated and uplifted by the conversation. People also make friends with like-minded survivors and gain confidence. Enrolling people in the program is easy, and can be done online.

    Having access to the My Stroke Journey program is a vital part of the clinical pathway and an integral part of rehabilitation. It is vital to include caregivers so they can share their knowledge and experience and learn more about the common after-effects of a stroke, such as personality changes, speech problems, loss of vision, memory loss, and more.

    To find out more about My Stroke Journey, reach out and contact us today.

    Stroke Risk Factors

    July 7, 2022

    A Happy family celebrating stroke recovery

    According to the American Stroke Association, stroke is the fifth leading cause of death in the United States, with nearly 800,000 people suffering one each year.

    Quickly recognizing a stroke is key to a patient’s prognosis, but the greatest emphasis should be on stroke education and prevention. Identifying the major stroke risk factors and making the necessary lifestyle changes are the best ways to reduce the number of stroke sufferers.

    Types of stroke and Symptoms of stroke

    There are two main types of strokes: hemorrhagic and ischemic. In addition, patients can suffer a TIA (transient ischemic attack), also known as a “minor-stroke”. The characteristics of these strokes include:

    • Ischemic stroke: 78% of all strokes are ischemic and occur when the artery to the brain becomes blocked, depriving the brain of oxygenated blood.
    • Hemorrhagic stroke: These strokes occur when an artery in the brain leaks or ruptures, causing blood to put pressure on the brain and damaging brain cells.
    • Transient Ischemic Attack (TIA): These minor-strokes are caused by temporary blockages of the artery to the brain, and typically resolve in five minutes or less. They are a sign that a major stroke is on the way and should be treated as a medical emergency. Note: We intentionally do not refer to TIA’s as “mini-strokes”

    The symptoms of a stroke are sudden instances of:

    • Numbness or weakness, particularly on one side of the body, including the face, arm, or leg
    • Cognitive difficulties, including confusion, impaired speech, or difficulty understanding others
    • Difficulty seeing through one or both eyes
    • Severe headache with no apparent cause

    One quick and effective way to identify a stroke is the BEFAST method, endorsed and used by doctors, nurses, and EMTs. BEFAST stands for the following;

    • B– Balance. Has the patient suddenly lost their balance?
    • E– Eyes. Has the patient suffered vision loss?
    • F– Face. Is the patient’s smile uneven?
    • A– Arm. Check for weakness or numbness in one arm.
    • S– Speech. Is the patient’s speech slurred?
    • T– Time. Act quickly and call 911 immediately.

    Main Stroke Risk Factors

    Although strokes are far too common, patients can lower their chances of having one by addressing the main risk factors. These stroke risk factors can be categorized as modifiable and non-modifiable.

    Modifiable stroke Risk Factors

    • High blood pressure: Readings of 140/90 can cause damage to the arteries that supply blood to the brain.
    • Heart disease: Heart disease and stroke share many risk factors.
    • Diabetes: Those with diabetes face a higher risk of stroke.
    • Smoking Smoking can nearly double the risk of an ischemic stroke.
    • Oral contraceptives: Using birth control pills raises stroke risk.
    • High cholesterol and lipids: These can cause a buildup of plaque in blood vessels and block blood flow to the brain.
    • Lack of exercise and obesity: Associated with poor health in general, these conditions raise the risk of stroke as well.
    • Alcohol use: More than two drinks a day may raise blood pressure, which increases the risk of stroke.
    • IV drug use: Using IV drugs raises the chances of blood clots and stroke.
    • Heart abnormalities: Those with heart abnormalities face a higher risk of stroke.

    Non-Modifiable stroke Risk Factors

    • Gender: Men are more likely to have a stroke, but more women die from them. Additionally, stroke kills twice as many women as breast cancer each year. This increased risk in women is due to factors including pregnancy, preeclampsia, oral contraceptives, hormone replacement therapy, migraines with aura, and atrial fibrillation.
    • Age: The risk of stroke increases with age, however, 10% of strokes occur in people under 50.
    • Race: African American men are more prone to high blood pressure than white men, which makes them more prone to strokes as well.
    • Heredity: Having family members who have experienced a stroke will increase your risk
    • History of prior stroke or TIA: If you’ve experienced a stroke or TIA, your risk of having another one significantly increases in the days and weeks following the initial stroke.

    Take Action to Help Prevent a Stroke

    Fortunately, patients can greatly reduce their risk of stroke by making healthy lifestyle changes, including:

    • Healthy diet: Eat a diet low in saturated fats, trans fats, cholesterol, and salt. Eat plenty of fiber and include fresh fruits and vegetables.
    • Healthy weight: If you are obese or overweight, lose some pounds to lower your risk.
    • Regular exercise: The Surgeon General recommends that adults get 30 minutes of moderate to intense physical activity each day, such as walking, jogging, or yard work.
    • Quit smoking: One of the best things you can do for your overall health and wellbeing is to quit smoking. Doing so lowers your stroke risk, and also reduces risk of heart attack and many other maladies.

    Controlling health conditions such as high blood pressure, diabetes, and heart issues is key to preventing strokes. Stress contributes to stroke risk as well, so try and manage your life pressures; seek help from a mental health professional for assistance in easing mental and emotional strain.

    The Sevaro Advantage

    Sevaro provides evidence-based teleneurology, specializing in emergent stroke care. When you choose Sevaro as your trusted hospital partner, you improve the care and prognosis of stroke victims. Your ED staff can reach a vascular neurologist in under 45 seconds, which means the right treatment decisions are made faster, improving patient outcomes. Our telestroke and general teleneurology services bring enhanced medical care to partner hospitals and their patients across the country, and help stroke victims recover faster and more fully.

    Sevaro also offers stroke survivors and caretakers a free monthly support group that helps them cope with the pressures their circumstances may bring. For more information on Sevaro’s teleneurology services, please fill out this brief online form.

    Hospitals have many options for telestroke partners, but only one option dedicated exclusively to teleneurology and revolutionizing and personalizing telestroke care. When time is everything, Sevaro will stand by you, your staff, and your patients to save time, save brain, and save lives.

    Sevaro = Simple: 4 Step Hospital Implementation

    June 30, 2022

    A team of providers teaming up together

    At Sevaro, we ensure the smoothest hospital implementation process to help our partner’s medical staff receive the specialized support they need for optimal patient outcomes. Much like no two patients are the same, no two hospitals are the same, so we customize our onboarding process to each new partner.

    Specialized stroke care remains a prioritized concern among healthcare providers. Stroke-related deaths have continued to rise in the last three decades, yet the ASA (American Stroke Association) notes that 80% of stroke cases are preventable.

    Through game-changing telemedicine technology like Sevaro OneCall™, Sevaro offers swift emergent care for acute neurology patients. However, to have Sevaro’s time and life-saving support system in place, it is necessary to guide hospital staff through a learning process.

    Therefore, our team has developed a structured approach that aligns seasoned, boarded vascular neurologists with on-site staff from the earliest stages of implementation.

    Sevaro’s Implementation Process

    The multidisciplinary team within a hospital needs to stay in lock-step alignment for the smoothest implementation to occur Sevaro begins by grouping on-site teams together to gather a thorough understanding of the standard workflows and practices within the hospital.

    Step 1 – Meeting the Team

    Our service team plans a meeting with hospital staff (including clinical, organizational, and administrative staff managing the OneCall service) to learn more about how things are done and identify where Sevaro can supplement existing processes. Both teams will collaborate to develop a detailed implementation roadmap.

    Sevaro signs a Master Service Agreement with the hospital team once all parties clarify their respective roles, liabilities, and responsibilities with the implementation. Timelines (i.e., product activation), budgets, and other resources are shared to help collaborators stay on target. Goal alignments are the highlight of the initial step.

    Step 2 – Licensing and Credentialing

    Sevaro collaborates with the hospital team to assess and confirm the medical license and expertise of a small team of specialists assigned to the house staff. The hospital’s Management Services Organization (MSO) compiles the professional information for licensed accreditation.

    The authentication process includes clinical performances and the scope of approved patient care services.

    Step 3 – Clarifying Procedures

    We ensure that the Sevaro team works seamlessly with the hospital staff by organizing in-person site visits. Our team will learn more about hospital systems, and establish rapport and cultivate relationships with the hospital staff so we learn how we best work together as a team.

    As part of the process, a member of the Sevaro team will work with the ED (emergency department) to discover the protocols and methods of improving the implementation accordingly. Through real-time observations and collaboration, our team establishes realistic responses with hospital staff.

    Step 4 – Mock Consultations and Beyond

    Sevaro conducts mock consultations before going live to fine-tune systems and minimize errors through realistic scenarios. Specifically, Sevaro technicians will be on-site at the hospital to test OneCall and Synapse 2.0, our voice-activated medical record that allows physicians to receive the information necessary to make rapid treatment calls. The mock-up phase usually takes between one to two weeks as hospital teams navigate the Sevaro system to fine-tune their telemedicine response.

    While the entire implementation process may last between 90-120 days, Sevaro maintains consistent check-ins throughout the process to ensure that all systems are operating with maximum efficiency.

    How Does Sevaro Simplify the Process?

    Our team prioritizes clear communications from day one. We initiate transparent discussions with hospital teams to set realistic expectations before each teleneurology implementation. As such, we recognize the specific challenges faced by our partners and identify the most suitable solutions according to their unique needs to facilitate the most prompt and timely responses.

    Sevaro’s team is always willing to educate doctors, nurses, and hospital staff on best practices, based on accrued on-the-ground experience from past collaborations. With open communication, we will help teams collaborate with a frictionless arrangement that optimizes the Sevaro experience.

    A key differentiator about Sevaro is that we provide a small team of top vascular neurologists (usually comprised of 12 doctors or less) with the experience and expertise to offer the highest level of patient care and treatment through specialized communication.

    Rather than disrupting current hospital workflow and practices, Sevaro seeks to learn and become a part of an existing system. Our versatile team operates with a tech-agnostic approach, ready to work with the technology provided by hospitals and to document in their EMR. Partners can expect minimal onboarding, and reliable support when required.

    Sevaro’s goal is to establish lasting professional relationships with healthcare staff and to help deliver consistent and high-quality telemedicine service across every hospital setting.

    Why Partner with Sevaro

    Sevaro is a physician-led company that continues to improve telestroke responses and patient outcomes with evidence-based care. The Montana Hospital Association (MHA) recently named Sevaro as their preferred stroke care and management vendor.

    Our team remains highly dedicated to supporting hospitals with the specialization in responding to time-sensitive stroke emergencies. Research shows that Sevaro reduces acute neuro-transfer rates by as much as 90%, DTN (door-to-needle) time by as much as 50%, and in-patient LoS (length of stay) by up to 25%.

    We will differentiate and expand your hospital’s care services. By partnering with Sevaro, your healthcare organization can look forward to optimized 24/7 telestroke and inpatient teleneurology assistance that delivers the best patient outcomes. Choose Sevaro as your trusted teleneurology partner today.

    A Regional Medical Center Partnership in Florida

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

    Hospital Background

    A Regional Medical Center with a 235-bed acute care hospital that prides its organization on the “Tradition of Quality.” Accredited by the Joint Commission, they have provided services to their region of Florida since 1986. In 2019, the hospital served approximately 51,000 patients.

    The hospital has utilized Sevaro as their preferred telestroke provider since January 2020. The partnership began in collaboration to help care for their acute neurological patients.

    In 2021, the hospital received the DNV Comprehensive Stroke Center Certification, the highest level of achievement for stroke certifications. This accreditation confirms that the hospital provides the highest quality care from clinical guidelines established through evidence-based research and practice.

    Industry Background

    • Every year, more than 795,000 people in the United States have a stroke [1]. About 610,000 of these are first or new strokes [1]. Out of those, 87% are acute ischemic strokes (AIS) caused due to a lack of blood flow to the brain tissue [1].
    • Stroke is the leading cause of disability and the second-leading cause of mortality worldwide [1]. Intravenous tissue plasminogen activator (tPA) which can be administered to AIS patients within 4.5 hours from the last known well (lkw) has shown benefit [2,3].
    • Shorter door-to-needle times (DTN’s) have been shown to reduce morbidity, mortality, and adverse events such as intracranial hemorrhages [2,4].
    • Even though tPA has shown a clear benefit, only a small percentage of acute ischemic stroke patients receive this treatment [9,10,11]. The most common reason has been the arrival of the patient to the hospital after symptom onset. The supply of neurologists, although ensuing an upward trend, the demand-supply ratio is trending up (12).
    • Specialized neurological evaluation of AIS patients has been shown to reduce the length of hospital stay (13). In institutions where local stroke expertise is not available, accumulating data suggest that tPA treatment can be performed safely and effectively via telestroke [14].
     

    The Partnership

    “The partnership with Sevaro has been an extremely successful relationship for our team. Their rapid response to our emergency calls has made them stand out from the competition. Having worked with multiple different teleneurology companies over the years, it has been a pleasure to work with such a responsive, collaborative, professional group of people.

    In conjunction with our stroke program, using technology such as Viz AI jointly with Sevaro keeps us on the cutting edge of stroke care and rapidly treating stroke patients.”

    -Hospital Chief of Staff

    A Regional Medical Center has partnered with Sevaro since January 2020 to provide acute neurology care for their patients. A premium comprehensive stroke center, they had a solid process in place before partnering with Sevaro. Even so, their average door-to-tPA administration time was 46 minutes from January 2020 – November 2020. The utilization of tPA during that time was 26%.

    Even though their 46-minute average was better than most hospitals in the U.S., there was still room for improvement. To meet the requirements of the Comprehensive Stroke Center Certification through the DNV, one must administer tPA within 60 minutes at least 75% of the time and within 45 minutes at least 50% of the time. At that moment, the hospital and Sevaro’s leadership decided to change the acute stroke protocol for the emergency room.

    The Process & Solution

    Sevaro has a team of boarded, seasoned vascular neurologists and medical technology experts that have worked in over 100 hospitals across the country. Sevaro’s experienced and collaborative team allowed the best practice and standards of care to help drive faster and more efficient care by integrating the clinical necessities with the highest quality technology.

    Sevaro is committed to data-driven neuroscience, high-priority care, and works with each of their partner hospitals to refine the process to deliver results.

    After the initial analysis of the process, the hospital and Sevaro collaborated to identify areas for improvement.and immediately implemented the following protocols for improved patient care.

    The Result

    The following is the data after the implementation of this new process (January 2021 – October 2021)

    • Average door-to-needle time of 37 minutes, with the record DTN being 21 minutes
    • 22% reduction in door-to-needle times
    • tPA utilization of 38%
    • 12% increase of tPA utilization before implementation of the new process
    • Faster identification of LVO (large vessel occlusion) patients and notification to neuro interventionalist

    For every stroke code, the hospital provider was able to talk to a Sevaro vascular neurologist within 45 seconds.

    Summary

    After a successful implementation of the Sevaro date-driven evaluation process at the hospital, the results were:

    • Enhanced communication between the ED staff and Sevaro vascular neurologist (45 seconds or less)
    • Faster DTNs
    • Increased tPA utilization
    • More timely identification of LVO patients.

    The hospital was asked to present at the National Emergency Conference for its exceptional stroke process improvement as one of the top six hospitals in the country.

    They credit their partnership with Sevaro as critical to enabling them to emerge as a contender for recognition as one of the top hospitals in the Nation.

    Appendix

    • Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association external icon. Circulation. 2020;141(9):e139–e596.
    • Saver JL et al. Time of treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA. 2013;309(23):2480-2488.
    • Mitka M. Early treatment of ischemic stroke with intravenous tPA reduces risk. JAMA.2013;310(11):1111.
    • Meretoja A et al. Stroke thrombolysis: Save a minute, save a day. Stroke. 2014;45(4):1053-1058.
    • Nogueira RG et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. The New England Journal of Medicine. 2018;378(1):11-21
    • Albers GW et al. Thrombectomy for stroke at 6 to 16 hours with selection perfusion imaging. The New England Journal of Medicine. 2018;378(8):708-718.
    • Berkhemer OA et al. A randomized trial of intraarterial treatment for acute ischemic stroke. The New England Journal of Medicine. 2015;372:11-20.
    • Jovin TG et al. Thrombectomy within 8 hours after symptoms onset in ischemic stroke. The New England Journal of Medicine. 2015;372(24):2296-2306.
    • Fang MC, Cutler DM, Rosen AB. Trends in thrombolytics use for ischemic stroke in the United States. Journal of Hospital Medicine. 2010;(7):406-409.
    • Katzan IL et al. Utilization of intravenous tissue plasminogen activator for acute ischemic stroke. Archives of Neurology. 2004;61(3):346-350
    • Adeoyle O et al. Recombinant tusse-type plasminogen activator use for ischemic stroke in the United States: A doubling of treatment rates over the course of 5 years. Stroke. 2011;42(7):1952-1955.
    • Burton A. How do we fix the shortage of neurologists? Lancet Neurol. (2018)17:502-3. Doi:10.1016/S1474-4422(18)30143-1.
    • Freeman WD wt al. Neurohospitalists reduce length of stay for patients with ischemic stroke. Neurohospitalist. (2011) 1:67-70. Doi: 10.1177/1941875210394202
    • Kepplinger J et al. Safety and efficacy of thrombolysis in tele stroke: A systematic review and meta-analysis. Neurology. 2016 Sep 27;87(13):1344-51. doi: 10.1212/WNL.0000000000003148

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

    Schedule a demo or give us a call today!

    Enroll a stroke survivor by entering in the information below

      The Sevaro Physician Difference – Neurology And Vascular Neurology Board Certifications

      June 7, 2022

      Elevating Stroke Care and Neurology Services

      The physicians at Sevaro bring inherent value to differentiate neurology and vascular neurology & expand the care your hospital is seeking in Emergent Stroke Care, General Neurology, and EEG Reads.

      At Sevaro, we bring a distinctive value to hospitals seeking advanced stroke care, general neurology, and EEG reads. Our physicians are not only dedicated to the field of neuroscience but also possess deep experience that spans from their work at some of the country’s most prestigious Academic Medical Centers (AMCs) and Comprehensive Stroke Centers (CSCs).

      Expertise Built on Experience at Top Institutions

      Sevaro’s neurologists and vascular neurologists are distinguished by their board certifications and their extensive experience in working with top-tier AMCs and CSCs across the United States. These aren’t just qualifications that were earned during training or fellowships; they represent active, hands-on experience that continues today.

      Why does this matter?

      • Reduced Mortality Rates: Research shows that experience in AMCs can reduce mortality rates. Sevaro’s team has honed their expertise at these leading institutions, bringing that knowledge to every patient they treat.
      • Innovators in Telehealth: Many of Sevaro’s physicians were pioneers in telehealth, telestroke, and teleneurology, helping to establish these models of care as critical components of modern stroke care.

      Sevaro’s doctors have been instrumental in building comprehensive stroke programs, utilizing telemedicine technology as a key component of patient care. Their work goes beyond theoretical knowledge; it’s rooted in years of practical application in the field.

      The Evolution of Telehealth in Stroke Care

      Teleneurology and telehealth have come a long way since their inception. In the mid to late 2000s, Sevaro’s physicians were among the first to integrate these innovative technologies into stroke care. Their experience in setting up and maturing telestroke programs at both Primary and Comprehensive Stroke Centers is invaluable to any hospital looking to build or enhance its own program.

      Key contributions by Sevaro physicians:

      • Introduction of Telehealth at PSC/CSC: Sevaro was at the forefront of introducing telehealth to stroke care, setting up virtual platforms that expanded access to neurologists, allowing hospitals to respond quickly and effectively to stroke emergencies.
      • Refinement of Processes: With a focus on continuous improvement, Sevaro physicians have developed and refined workflows, leveraging telemedicine to improve response times, reduce transfers, and ultimately enhance patient outcomes.
      • Building Comprehensive Stroke Centers: Sevaro’s team has worked closely with over 17 CSCs nationwide, contributing to the development of some of the most successful stroke programs in the country.

      Sevaro’s Active Role in Reducing Mortality Rates

      Sevaro physicians continue to play an active role in stroke care at top Comprehensive Stroke Centers. Their experience and expertise translate into real-world results that benefit hospitals and patients alike. In addition to stroke care, their work encompasses a broad range of neurological services, including EEG reads, movement disorder treatments, and more.

      Sevaro’s physicians don’t just treat patients; they also work to improve hospital processes, ensuring that care is delivered as efficiently and effectively as possible.

      Advantages of working with Sevaro:

      • Comprehensive Knowledge of CSC/PSC Programs: Sevaro physicians have a deep understanding of what it takes to build, manage, and grow a Comprehensive Stroke Center. Their hands-on experience makes them ideal partners for hospitals looking to advance their stroke care programs.
      • Commitment to Continuous Improvement: Sevaro physicians are dedicated to refining hospital processes and introducing best practices that improve patient outcomes.
      • Collaboration with Hospital Staff: Sevaro physicians don’t work in isolation. They collaborate with hospital staff to ensure that care is delivered seamlessly, even in the most complex cases.

      Applying Best Practices Every Day

      At Sevaro, we take the lessons learned from years of experience at the top Comprehensive Stroke Centers and apply them to our care delivery every day. Whether it’s a complicated patient case, a process adjustment, or a system overhaul, Sevaro’s physicians have the expertise to make it happen.

      Our goal is to not only meet your hospital’s immediate needs but also to push the boundaries of what’s possible in neurological care.

      How Sevaro can benefit your hospital:

      • Implementation of Telehealth: Sevaro’s experience in introducing telehealth to stroke care can help your hospital build or enhance its own telestroke program.
      • Process Improvement: Sevaro physicians bring with them the best practices of top Comprehensive Stroke Centers, improving patient outcomes through continuous improvement.
      • Comprehensive Stroke Center Development: Sevaro can help your hospital take its stroke care program to the next level, whether you’re looking to become a Primary Stroke Center, Comprehensive Stroke Center, or simply improve your current processes.

      Why SOC 2 Matters to Sevaro

      Whether your hospital is just beginning its journey toward building a Comprehensive Stroke Center or you’re looking to improve an existing program, Sevaro has the expertise to help. With years of experience in developing, refining, and leading stroke programs at top institutions, Sevaro is the partner you need to advance your hospital’s stroke care.

      By integrating telehealth and best practices into your hospital’s care delivery, Sevaro can help you reduce mortality rates, improve patient outcomes, and deliver the highest quality of care.

      *References:
      https://jamanetwork.com/journals/jama/article-abstract/2627971 – Lower stroke mortality rates at AMCs

      Tenecteplase for Acute Ischemic Stroke

      June 6, 2022

      Nurse Practitioner or Physician Assistant- Neurology

      Part Time

      Job Details

      Position title

      Nurse Practitioner or Physician Assistant- Neurology

      Shift Availability

      Part-time

      Comapny Vision

      Sevaro is a data-driven Teleneurology company bringing clinical quality, academic training, innovation, and modern technology to the market. Our compassion or “Seva” pushes us to serve others without expecting anything in return. Sevaro was designed for physicians, by physicians! We are vascular trained neurologists with experience at academic medical centers focused on creating stroke survivors.

      Position Highlights

      As a Nurse Practitioner in Neurology, you will support our Neurology Physicians in examining neurology patients virtually in the inpatient and outpatient setting using telemedicine technologies. This exciting opportunity offers the ability to provide best-in-class patient care with an extremely competitive pay and a flexible work life balance.

      Sevaro’s innovative solution allows our providers to achieve better patient outcomes. Sevaro values physician satisfaction and work-life balance. Our dynamic team creates an exciting culture that enables physicians to grow with the company.

      You don’t work for us
      you grow with us!

      Position Requirements

      • Excellent communication skills with a focus on physician-patient interaction
      • Comfortable with using audio/video technology, EMRs and PACs
      • Preference given for those with Teleneurology experience
      • Completion of an accredited Nurse Practitioner or Physician Assistant program
      • Possess or able to obtain an unrestricted Medical License in any US State
        **Preference given to LA, AL, SC, KS, KY, AR, CA, TX, NY, NJ, FL, MI, IL, IN, MO, NC, TN, and GA licensed providers
      • Hospital-based Neurology and Stroke experience preferred

      Program Offering Includes

      • Competitive compensation package
      • Flexible scheduling
      • Incredibly collaborative work culture amongst physicians
      • Brand new laptop
      • Co-create digital health technologies
      • Participate in research and clinical trials
      • Guest speaker appearances

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

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

      Introduction

      Stroke is the 5th leading cause of death in the United States and the leading cause of serious long-term disability. In some states such as Illinois, stroke is as high as the third leading cause of death. Despite The American Heart and Stroke Association and countless other advocacy groups continually educate the public on the risk factors associated with stroke, rates have continued to rise. Perhaps more shocking is the rate of strokes in younger populations. According to one study, current rates of stroke in patients aged 18-45 have increased by 40% over the last several decades and patients still have trouble recognizing the symptoms.

      Identification of stroke symptoms and expedited care are two of the best options we have when stroke prevention fails. EMS and Emergency Department staff are offered training through numerous organizations to identify stroke symptoms and are encouraged to act swiftly. However, Emergency Departments can often be a chaotic, unpredictable environment and lack the necessary expertise to differentiate stroke from other traumatic or disease presentations. When vascular neurologists are not onsite, telemedicine is used to bridge this gap.

      While many organizations have set out to standardize the steps and timeframes with which to provide stroke care there is no standardized approach to connect a vascular neurological specialist through telehealth with the same type of urgency. Acting swiftly to connect with the specialist is paramount when “Time is Brain” as they say. Some associations such as the American Telemedicine Association (ATA) have hinted towards creating a quick connection with off-site-based physicians. The ATA’s guidelines only stating that the service “may have turn-around time requirements.” While the DVN-GL takes a harder stance to put a hard parameter on the turnaround time stating that the “neuro consult should be available within 20 minutes from the initiation of the stroke alert.”3 This paper looks to outline the approaches used to establish the connection for the consult and outline the pros and cons of each in its association with expedited care.

      Current Methods

      Call Centers are a common approach for both health system-based Telestroke networks and physician services organizations that contract to provide telestroke services. Workflows require the hospital staff to speak with an intermediary before speaking with the teleneurologist.

      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 New Approach

      While the use of call centers, telehealth platforms, and healthcare-specific communication applications all offer the ability to connect with a teleneurologist they currently lack the ability to create the connection between the offsite physician and the onsite care team within a specified amount of time. When stroke symptoms are present a Telestroke program must take into consideration all facets of connection time between the onsite care team and the offsite teleneurologist. After all, approximately 1.9 million neurons are lost during every minute of an ischemic stroke, and any communication system that either impedes, delays, or disables communication with the teleneurologist should be examined.

      Traditional Telestroke programs take advantage of having a group of teleneurologists cover many hospitals at once. Up until now complicated on-call schedules, coordination of privileged physician staff to the right hospital and the shortage of vascular neurologists have plagued the industry’s ability to utilize a direct link to the teleneurologist.

      Sevaro OneCall aims to change that by delivering an intelligent physician scheduling tool and call routing system by dialing one number that directly calls the teleneurologist. Sevaro OneCall’s premise is that healthcare decisions can be made much more quickly when the requesting healthcare provider is able to communicate live with the teleneurologist at the exact moment that the consultation is requested. Hospitals are able to:

      • Connect Within 45 Seconds
      • Make Treatment Decisions Immediately
      • Automated Routing To The Backup Physician
      • Timestamp Important Stroke Related Metrics

      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

        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.

        Enroll a stroke survivor by entering in the information below

          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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