Time is critical when patients experience a stroke, and now North Kansas City Hospital physicians can more quickly respond — thanks to a new teleneurology program that virtually brings telestroke specialists to the hospital 24/7.
Improved Door-to-Needle Times
Through real-time video conferencing, telespecialists assess patients, view CT scans and advise NKCH physicians on whether stroke therapy is indicated. Whether a patient comes through the Emergency Department or presents as an inpatient with stroke indications, the NKCH consulting emergency physician or hospitalist, respectively, electronically collaborates with a board-certified neurologist.
Although NKCH began working with the telespecialists April 7, the NKCH first patient’s tissue plasminogen activator door-to-needle time was 22 minutes. At other hospitals, the telespecialist group has improved standard 60-minute door-to-needle times to 45 minutes or less.
ED “Pit Crew”
The Emergency Department also streamlined its process with a pit crew technique, where patients with stroke indications are not brought to an ED bay but instead to a dedicated ED pit stop.
During a maximum 5-minute pit stop, a nurse takes vitals, and a physician completes a mini-assessment and activates a Code Stroke, if needed. This spurs moving the patient to Radiology for a CT scan and a video conference to a telespecialist, who immediately begins a full stroke assessment, monitors the CT scan and determines treatment. The telespecialist works in collaboration with the NKCH ED physician.
For inpatients experiencing a stroke, a Code Stroke is called and the telespecialist is brought in once the patient is moved to Radiology for a CT scan. After the acute treatment phase, NKCH hospitalists may opt to consult with a Meritas Health neurologist.
“In the past we relied on on-call neurologists to come to inpatient and ED patient bedsides,” said Brenda Swihart, BSN, RN, stroke program manager. “Such immediate and consistent availability with telespecialists assures that patients having an acute ischemic stroke receive the needed intravenous tPA to dissolve the clot and improve blood flow to the brain as quickly as possible, if the patient qualifies.”
Other treatment options are considered if the patient is outside the treatment window or when there is a hemorrhagic stroke.
“Most important is to provide early treatment to preserve brain cells, improve function and reduce disability,” Swihart added.