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

Sevaro Case Study

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 telestoke 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.

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