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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

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