“Connect to Quality”

The Reality of Telestroke:Real People, Real Results

James M. Kiely, MD, PhD

CIO; AcuteCare Telemedicine

2014 Florida Telehealth Summit

“Connect to Quality”

“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 disabilityCirculation 129:399-410, 2014

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Stroke Belt

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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

• 12 Regional Telehealth Resource Centers (TRC)

• 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 ThrombolysisCerebrovasc 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” 16

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, PhD

CIO; AcuteCare Telemedicine

2014 Florida Telehealth Summit

“Connect to Quality”