Minutes that Matter – Advancing the Field of Neurology with Direct Physician Access
Minutes that Matter – TeleStroke Patient Outcomes Advance the Field of Neurology and Medicine
The American Stroke Association (ASA) notes that “80% of strokes are preventable”. American Heart Association - CDC Prevention Programs | American Heart Association That 80% is what drives Sevaro Physicians to keep access speed a critical starting point of caring for each Sevaro stroke patient. Sevaro Health’s mission; “To improve patient outcomes by providing the highest quality of specialty care and maximize our impact through the use of data and compassion” is a 24/7 and minute to minute mission delivered each and every day by Sevaro Physicians.
Why is the element of time, or minutes so important to accessing stroke care treatment ? The ASA defines stroke as;
“a disease that affects the arteries leading to and within the brain and the #5 cause of death and a leading cause of disability in the US. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood and oxygen needed, and brain cells die.”
The importance of mitigating brain cell loss in stroke is best illustrated by the American Hospital Association’s 2006 Journal Article, ‘Time Is Brain-Quantified’, and summarizes the brain cell loss for the average patient at 1.9 million neurons per minute in which a stroke is untreated. Time-sensitive treatment options for stroke must be presented to the patient within three to four and a half (3-4.5) hours of onset of symptoms, maintaining a reliance on access speed to the physician for timely care.
Table 1: ‘Time is Brain-Quantified’
Estimated Pace of Neural Circuitry Loss in Typical Large Vessel, Supratentorial Acute Ischemic Stroke
|Neurons Lost||Synapses Lost||Myelinated Fibres Lost||Accelarated Ageing|
|Per Stroke||1.2 billion||8.3 trillion||7140 km/4470 miles||36y|
|Per Hour||120 million||830 billion||714 km/447 miles||3.6y|
|Per Minutes||1.9 million||14 billion||12 km/7.5 miles||3.1wk|
|Per Seconds||32000||230 million||200 meter/218 yards||8.7h|
Sevaro brings innovation and speed to care together as it aligns with its hospital partners to ensure the process to contact Sevaro and initiate care is straight forward, fast, efficient, and reliable. Sevaro’s hospital partners have direct access to Sevaro physicians with OneCall, NO CALL CENTERS are used, allowing Sevaro to eliminate unnecessary steps where delays in care commonly occur and when minutes matter the most, stroke patients and Sevaro Physicians in 45 seconds or less.
There are five different types of stroke that effect patients every day (table 1) and the seconds and minutes that pass when a patient begins having a stroke are life-threatening. The faster an in-person qualified clinician can begin a treatment plan advised over live 2-way video by a board-certified vascular neurologist, the higher the probability to prevent the stroke from causing brain cell loss. Getting medical attention as soon as possible minimizes long term-effects of stroke and can prevent death. TeleStroke continues to be more prevalent over the last decade and has advanced stroke treatments and survival rates markedly.
Table 2: The Five Stroke Types and Descriptions
|Ischemic Stroke – Clots||A blood vessel supplying blood to the brain is obstructed. Ischemic Strokes account for 87% of all strokes.|
|Hemorrhagic Stroke – Bleeds||A weakened blood vessel ruptures, two types of blood vessels that cause a hemorrhagic stroke are aneurysms and arteriovenous malformations (AVMs). The most common cause of hemorrhagic strokes is uncontrolled high blood pressure.|
|Transient Ischemic Attack or “TIA”||Mini stroke caused by a serious temporary clot. This often comes as a warning to the patient that a more serious stroke could be possible.|
|Cryptogenic Stroke||The cause of the stroke cannot be determined, unknown cause.|
|Brain Stem Stroke||The stroke occurs in the brain stem, can affect both sides of body and may leave patient unable to speak or move below the neck.|
Minutes that Matter – Stroke Treatment is Time-Sensitive and Life-Saving
The FDA has only one approved treatment for Ischemic Strokes, Alteplase IV r-tPA (Tissue Plasminogen Activator). If a patient meets eligible criteria during the stroke' video consultation, tPA will be recommended by the board-certified vascular neurologist and administered by the local care team. tPA works through IV, releasing/breaking the clot and returning blood flow to the effected areas.
A time-sensitive requirement of having tPA administered within three to four and a half (3-4.5) hours of the patient’s initial onset of symptoms is necessary to realize tPA’s benefits. Benefits of a patient receiving tPA within the time frame improves the recovery, disability effects, and can sometimes reverse symptoms entirely immediately after administration. Patients can have severe paralysis, speech difficulties, and other symptoms return to full normal function following tPA. Once administered by the local care team, the patient is monitored and assessed frequently in an ICU by the vascular neurologist and the local care team. Patients who do not receive fast treatment for their stroke can have life-long devastating disabilities.
Additional treatment options for all strokes include Endovascular Procedures, a stroke treatment to remove the clot using a guided catheter at the site of the brain’s blocked blood vessel. Patient eligibility criteria varies. Neurosurgical care teams may administer tPA directly into the blood clot (intra-arterial) to dissolve the blockage or assess options to remove the clot.
Sevaro OneCall – When Minutes Matter the Most, Sevaro Direct Physician Access Brings Speed and Simplicity to Life Saving Care
The entire Sevaro team is dedicated to access speed and actively involved with pilots and research initiatives that are tracking stroke patient outcomes and the positive impact that new innovations and process changes have on industry benchmarks. Regular and ongoing collaboration between Sevaro and its Hospital partners are valued relationships to sustain a continuous improvement culture for stroke patient outcomes.
Together, Sevaro and a Hospital partner piloted the innovative process of removing the call center step from the process the hospital used to contact the Sevaro physician. That initial pilot removed several minutes from the process immediately and the times for reaching a Sevaro Physician were now being tracked in seconds. The pilot sustained and fast forward to today, Sevaro OneCall or direct physician access (Sevaro physician answers phone first) is the way we implement and operate with every Hospital partner. The Sevaro OneCall process is a cornerstone of the quality care we provide. Benefits to the patient are clear savings in reducing valuable minutes of brain cell loss, and benefits to the local care team are immediate access to the board-certified vascular neurologist, no complicated call schedules to remember or call center representatives to wait on hold with, simply dial one number and speak directly with a Sevaro physician for faster treatment decision making.