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“Connect to Quality”
The Reality of Telestroke:Real People, Real Results
James M. Kiely, MD, PhDCIO; AcuteCare Telemedicine
2014 APT Annual Conference
“Connect to Quality”
In Lieu of an Opening Joke
“Hub & Spoke”
• Hub: Resources• Spoke: Need
• Telestroke Provider:• “The axle that turns the hub and
spoke”• Why? Stroke vs Neurologists• Outcomes… not just about
technology!
What is Stroke?
• Ischemic Stroke• clot or plaque blocks blood
flow and starves brain cells of oxygen
• 87% of strokes are ischemic
• Symptoms: • sudden weakness,
numbness, blindness or loss of speech
• Think “F.A.S.T” – Time is Brain!
Stroke Facts in the U. S.
• 795,000 Americans suffer strokes each year
• 134,000 deaths each year• 3rd leading cause of death
• 6,400,000 stroke survivors• #1 cause of serious, long-term disability
Circulation 129:399-410, 2014
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Stroke Belt
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Rank of 50 States & DC
Tennessee 51stAlabama 50thMississippi 46thLouisiana 45thGeorgia 44thFlorida 41st
Deaths per 100,000
58.156.353.352.651.535.3
American Heart Association; Heart Disease and Stroke Statistics, 2011 Update
Stroke-Related Death Rates
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“Connect to Quality”
Where are the Neurologists?
• National crisis of availability; primarily rural• Neurology 10:1212, April 2013
• Need minimum 2 for 24/7/365
• Lack of responsiveness
• Lack of comfort with tPA
A Brief History of Telestroke
• 1954 Harrison’s Textbook of Medicine: • “There is no satisfactory medical
treatment...”
• 1995 NEJM:• Intravenous tPA effective within 3 hours
• 2009 AHA/ASA Endorse Telestroke• Reduces barriers to acceptance
• 2012 Alabama Partnership for Telehealth• Created to facilitate telemedicine in rural
areas
Telestroke Results
• 30% improved at 3 months
• Time is Brain• 1.9 million brain cells every minute
• tPA 3 Hour Window• 4.5 hours select cases
• Door to Needle• “Golden Hour”
Telestroke Benefits Beyond Thrombolysis
Cerebrovasc Dis 2009;27 (Suppl. 4):21-27• Fewer unnecessary patient transfers
• Higher volume of care leads to better outcomes
• Higher satisfaction of medical staff
• Stroke Mimics
• Thrombectomy
Real Results: Stroke Mimics
• J.B. 76 yo presenting with left hemiparesis
• ICH; no tPA, thrombectomy?
• Cortical signs: head and gaze deviation
• Remote presence: deviation to left, clonic movement, Jacksonian March
• Wife recalls more history
• Admitted with Status Epilepticus
• D/C to Rehab after 1 week
Real Results: Thrombectomy
• D.S. 68yo “Wake Up Stroke”
• Aphasic, Hemiplegic
• Unknown time of onset
• Marcus Stroke Center: Perfusion Defect
• Puncture by 33 min, Retrieval by 29 min
• Recovery @ 2 Hrs
Thrombectomy: Real Results
Thrombectomy: Real Results
Real People, Real ResultsImplementing a Successful Program
“Connect to Quality” 18
Successful Relationships Require Strategic Goal Alignment
Real People Working Together for Real Results
The Reality of Telestroke:Real People, Real Results
James M. Kiely, MD, PhDCIO; AcuteCare Telemedicine
2014 APT Annual Conference
“Connect to Quality”