Remote Treatment Stroke Center Designation

Why and How McCord Smith, M.D.

May 14, 2015

Michael Frankel, MD

Problem

•We are not providing the best stroke care to the residents of GA.

• IV tPA 1996: 30% improved outcomes•USA 2014: 5% stroke pts receive tPA;

~1/3 of 800,000 could benefit

ISC 2014

Causes of Underuse

•Patients arrive at ED too late•Patients live too far from PSC

• Too few Neurologists

Why PSC

• Time imperative• Exclusions• Stroke Mimics• TJC designation 2004

Solution

PSC 2004CSC 2012RTSC 2013

Telestroke 2002

Georgia: a Special Case

• Large area•Rural• Stroke Belt (Buckle)•Coverdell 2001•REACH 2002

STM Experience

2000 Idea2004 PSC2009 Reorganize2013 Good Sam: RTSC2014 Int Stroke Conf

ST. Mary’s Experience # pts receiving t-PA % t-PA

•2002-2008 25 2.7%•Avg/year 3.6

•2009-2014 163 12.4%•Avg/year 27.2

FDA Data 1995mRS 0-1 2-3 4-5 6

St. Mary’s Outcomes 2009-2014 (163 patients)

Yes We Can

•2004: 20 PSC 2014: 1200 PSC• Target Stroke 2010 2013: >50% tPA patients

given with DTN < 60 min

How

•Commitment•Organization•Collaboration• Education•Help

Prevention

• Education

•Community involvement

Home

EMS

RTSC ER

TeleStroke

911

PSC

Acute Ischemic Stroke:

The BIG Picture

CSC

SX

tPA nontPA

We are not providing the best stroke care to the residents of GA.

•We are not in Kansas anymore