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Presentation by Charles Tegeler IV, MD, Wake Forest Baptist
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Improving Stroke Care in North Carolina:
The WFBH Telestroke Program
Charles H. Tegeler, MD
McKinney-Avant Professor of Neurology
Director, Telestroke Services
Director, Ward A. Riley Ultrasound Center
Stroke Death Rates by County of Residence, N.C., 2004-2008
Stroke: ICD-10 codes I60-I69. Rates per 100,000 population, age-adjusted to the 2000 U.S. standard population. N.C. Data Source: N.C. Center for Health Statistics. North Carolina Vital Statistics, Volume 2: Leading Causes of Death, 2008. Raleigh, N.C.: N.C. Dept of Health & Human Services; 2009. U.S. Data Source: Compressed Mortality File, CDC Wonder.
Death Rate
35.5 - 43.5
43.6 – 51.8
51.9 – 60.0
60.1 – 71.5
71.6 – 98.9
N.C. overall: 54.4
U.S. (2002-06): 49.8
WFBMC
Thanks to Paige Bennett
Wake Forest Baptist Health Kleindorfer et al, Stroke, 2009
Wake Forest Baptist Health
Hospital Predictors of tPA Use
MEDPAR Database, N = 4626 hospitals
Kleindorfer et al, Stroke, 2009
Small
South
Rural
Wake Forest Baptist Health
Telemedicine in Stroke: What is the Evidence?
Stroke 2009;40: 2616-34
WFBH Telestroke Services Motivations and Goals
• Time limited window of opportunity – Time is brain
• Gaps in access to Stroke Neurologists and to acute stroke Rx, without waiting for transportation
• Program Goals/Objectives:
• Improve stroke care in region/state
• Increase access to, and use of, tPA
• Encourage local care, but facilitate appropriate transfers who need higher levels of care
• Avoid unnecessary transfers
• Management Tool to enhance patient care relationships between WFBH & network hospitals
Wake Forest Baptist Health
WFBH Stroke Team Vascular Neurology (5), Vascular Neurosurgery (2), Interventional
Neurosurgery/Neuroradiology (3), Stroke Coordinator, Stroke NP,
Forsyth County EMS, Administrative Staff
Dr. Jeff Craig Dr. John Wilson Dr. Charles Tegeler Dr. David Lefkowitz Dr. Rashid Janjua
Rayetta Johnson, RN, Christina Condon, NP, Dr. Cheryl Bushnell, Dr. Pat Reynolds, Col. Dan Ozimek
Not Shown: Dr. Pearse Morris, Mike Waid, Lindsay Filoseta
WFBH Telestroke Services What did we end up with?
• 24/7 easy access to consultation with board-certified or
fellowship-trained Vascular Neurology Stroke Faculty via RP-
7 Remote Presence (In Touch Health)
• If needed: Preferential bed placement with rapid and
facilitated transfer with single “800” phone number
Wake Forest Baptist Health
WFBH Telestroke Services Current Snapshot
• Initial Network Hospital signed - 11/09
• Initial Network Hospital live - 12/09
• Through 2/12 – 276 calls, 187 robot consults
• Currently 9 Network Hospitals:
Lexington Memorial Wilkes Regional
Ashe Memorial Allegheny Memorial
Caldwell Memorial Carteret General
Davie County Hospital Catawba Valley
Lake Norman Medical Center
Wake Forest Baptist Health
Wake Forest Baptist Telestroke Network
= WFBH
= WF Telestroke Site
= WF WIP Site
Wake Forest Baptist Health
Telestroke Network Activity
Wake Forest Baptist Health
Network Activity Summary Accomplishing Our Goals
(12/31/11)
Network Total Regional sites Remote site
Total activations 246 161 85
Robot consults 163 (66%) 115 (72%) 48 (57%)
# Remained local 89 (55%) 58 (50%) 31 (65%)
Transferred to WFBH 54 (47%) NA
Transferred elsewhere 20 (12%) 3 (3%) 17 (35%)
# tPA 44 (27%) 32 (28%) 12 (25%)
Wake Forest Baptist Health
Patient Disposition When Robot Activated
tPA Administrations Pre and Post Telestroke Network Participation
Key Lessons Learned
• Telestroke requires a team effort
• Keep best patient care as first priority
• It’s all about relationships
• Get EMS on board even before contract signed
• Get financial issues settled up front
• Need to plan for ongoing in-service and education
• Consolidate/unify protocols between hospitals
• Share successes – feedback to hospital and EMS
• Network Users meeting/forum to share best practices
Wake Forest Baptist Health
Telestroke in North Carolina (October, 2010)
Wake Forest Baptist Health
Telestroke in North Carolina (January, 2012)
Wake Forest Baptist Health
Thank you for your attention