Memorial University Medical Center

Memorial Stroke and Telestroke Manager:Jessica B Aspinwall, RN, BSN

Memorial University Medical Center (MUMC)

• MUMC, founded in 1955, is a nonprofit, two-state healthcare organization serving a 35-county area in southeast Georgia and southern South Carolina.• 654-bed tertiary care hospital

• Regional referral center for cardiac care, cancer care, trauma, pediatrics, high-risk obstetrics, and neonatology. • Region's only Level 1 trauma center, children’s hospital and houses the

Savannah campus of Mercer University School of Medicine.

• One of the largest employers in the region, with approximately 4,500 Team Members

• In 2014: 25,666 admissions. 235,699 outpatient visits. Performed 21,327 surgeries. Delivered 2,765 babies. 95,243 emergency department visits. Average daily census 457. Average LOS 6.09 days.

Memorial Stroke Accolades

Memorial University Medical Center Awarded•Disease Specific Certification as a Primary Stroke Center by TJC

• Re-certified in February 2015

•Received American Heart Association/American Stroke Association’s Get With The Guidelines-Gold Plus Quality Achievement Award for 2012, 2013 and 2014.

• This award recognizes Memorial’s commitment and success in implementing a higher standard of stroke care by ensuring that stroke patients receive treatment according to nationally accepted standards and recommendations.

•Target:Stroke Honor Roll• Recognizes Memorial for treating at least 50 percent of eligible ischemic

stroke patients with tissue plasminogen activator, or tPA, within 60 minutes of arriving at the hospital (known as ‘door-to-needle’ time).

Stroke Facts

• Stroke is a “brain attack,” cutting off vital blood flow and oxygen to the brain

• Fifth leading cause of death (killing over 133,000 people each year) and the # 1 cause of serious, long-term adult disability

• Approximately 795,000 strokes occur each year• One occurring every 40 seconds & taking a life approximately every 4

minutes

• 87% Ischemic & 13% Hemorrhagic • MH: 76% Ischemic & 23% Hemorrhagic

• Two million brain cells die every minute during stroke• Women are TWICE as likely to die from stroke than breast cancer

annually

• Time Is Brain.

MUMC is an academic medical center that serves a 35-county area in southeast Georgia and southern South Carolina

Who we serve?

Berkeley

CharlestonColleton

Beaufort

Orangeburg

Bamberg

Aiken

Polk

Haralson

Carroll

Heard

Troup

Harris

Muscogee

Crawford

Stewart

Quitman

Clay

Early

Seminole

Miller

Baker

Calhoun

Lee

Dooly

Crisp

Houston

Jones

Bibb

Washington

Hancock

GreeneDe Kalb

Henry

Palding

Talbot

Upson

Laurens

JohnsonEmanuel

Candler

Bryan Chatham

Effingham

Screven

Burke

Richmond

Columbia

Appling

Wayne

Camden

Glynn

McIntosh

Pierce

Ware

Clinch

Echols

Lowndes

Brooks

Colquitt

Worth

Irwin

Ben Hill

Telfair

Dodge

Montgomery

Coffee

Atkinson

Grady

Barnwell

Hampton

Allendale

Dorchester

Cobb

Fulton

WilkesOconeeWalton

Newton

RockdaleDouglas

Monroe

Coweta

Fayette

Clayton

LamarPikeMeriwether

Jasper

SpaldingButts

TaliaferroMorgan

WarrenMcDuffie

Putnam Glascock

Jefferson

Jenkins

Bulloch

Twiggs

Wilkinson

Baldwin

Bacon

Brantley

CharltonThomas

Decatur

Toombs Tattnall

Evans

Long

Liberty

Bleckley

Pulaski

WilcoxJeff Davis

Wheeler

Sumter

Schley

Taylor

Macon

Peach

Dougherty

Terrell

Randolph

Webster

ChattahoocheeMarion

Lanier

Berrien

CookMitchell

Treutlen

Turner

Tift

Jasper

>100

30-100

5-29

<5

Trendstar Data: Jan 2013- Dec 2014

Stroke Population: Medical History

*Data: Outcome Science 2013 - 2014

Memorial’s Stroke Patient Population

*Data: Outcome Science 2013-2014

49% Female 51% Male

Memorial’s Stroke Patient Population

*Data: Outcome Science 2013-2014

59% Caucasian 40% African American

Stroke Patient: Mode of Arrival

*Data: Outcome Science 2013 - 2014

MUMC’s TeleStroke Program

• Web-based, telemedicine system• Combining real-time audio and video conferencing between hospitals• This allows the neurologist to evaluate the patient, perform a neurological

assessment, view the computed tomography (CT) scan, lab values, make a diagnosis and initiate treatment from virtually anywhere.

• “Go-Live” 2Q 2011• Bacon County Hospital Alma, GA (2011)• Jeff Davis Hospital Hazlehurst, GA (2011)• Meadows Regional Medical Center Vidalia, GA (2012)• Liberty Regional Medical Center Hinesville, GA (2014)• MH’s Emergency Department

• Partnership with Savannah Neurology Specialists• 9 local neurologists provide an on-site neurology Monday-Friday 7a-5p

• Provide 24/7 coverage to regional telestroke program

Tissue Plasminogen Activator (tPA)

• TPA is administered via IV and works by dissolving the clot and improving blood flow to the part of the brain being deprived. • Called: thrombolytic agent or a “clot buster”

• Only FDA approved drug treatment for acute ischemic stroke (1996)• Treatment window – 3 to 4.5 hours since onset of symptoms• If given promptly, 1 in 3 patients resolve symptoms or have major

improvement in stroke symptoms. • Risk: bleeding (hemorrhage) in brain or other parts of the body (6 out of

100 patients)

Emergency Department Acute Stroke Treatment: Code Stroke

MUMC 2014:

Median DTCT: 14 minutes

Median DTN: 54.5 minutes

Spoke Site: Acute Stroke Treatment

Telestroke Transfers

• Spoke Sites• Administer TPA in ED

• Patient transferred to MUMC for higher level of care• Flight→ Transport after 1st set of 15 minute vitals & neuro check

complete- ED MD evaluates patient prior to transport

• Ground→ Transport after 1 hour infusion in complete

TPA Data: Age & Gender

Data: Outcome Science 2014

Median Age: Female: 66 Male: 57.5

Female: 41.9% Male: 58.1%

TPA Data: Diagnosis & Gender

Data: Outcome Science 2014

DTN <60 min: 61.9% of patients

TPA All Patients LOS: 4.94 days

TPA Data: Race & Gender

Data: Outcome Science 2014

67% Caucasian 30% African American

TPA Data: Discharge Disposition

Data: Outcome Science 2014

MUMC: 4.2% Mortality & 1.8% post TPA Complications

TeleStroke Utilization

*Memorial’s Emergency Department is included in regional spoke sites*

Year# of regional spoke sites

# of acute neurological

consults

# of patients treated with

IV-tPA via telemedicine

% of patients treated with

IV-tPA via telemedicine

Total # of patients

treated with IV-tPA at MUMC

2011

3 14 2 14% 31

2012

5 33 19 58% 65

2013

5 43 21 49% 72

2014

5 59 33 56% 85

2015 (YTDMarch)

5 13 8 62% 23

Benefits of Memorial’s TeleStroke Program

• Builds regional relationships• Promotes collaboration between clinical teams• Decreased travel time and expenses for patients (decrease unnecessary

transfers)• One call for seamless patient transfer (Transfer Center)

• Access to local neurological expertise • Enables remote consultations

• Decreased response time in acute stroke (DTN)• Increase the number of eligible patients who receive IV-tPA

or other time sensitive interventions• Improve patient outcomes, decrease stroke related

disability, and reduce health care cost

• High patient and family satisfaction survey scores

Questions?