“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

“Connect to Quality”

Stroke Belt

“Connect to Quality”

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

“Connect to Quality”

“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”