Community hospitals across North Carolina and Virginia are transforming stroke care by teaming up with the Duke Telestroke Network. Through real-time, virtual consultations and expert-led program development, local hospitals gain 24/7 access to Duke stroke specialists and a comprehensive approach to stroke care. The result? Faster treatment, improved outcomes, and more patients staying close to home—with advanced stroke certifications to match.
Challenge
In the U.S., almost 800,000 people suffer a stroke each year. Immediate care during a stroke can prevent death and brain damage, but smaller hospitals frequently lack the resources to provide high-level care. Patients with stroke need advanced, timely processes and evaluation to help determine the best treatments and offer the best outcomes.
Solution
These local hospitals joined the Duke Telestroke Network for access to Duke stroke specialists around the clock as well as stroke program development including evidence-based protocols, guidelines and policies for stroke care.
Via telemedicine video conferencing, a Duke neurologists consults with patients, families, and local providers and views patients’ CT scans. Based on this information, the neurologist helps the local physician make decisions about how to manage patients with symptoms of an acute stroke in the Emergency Department and Inpatient units based on the stroke type.
When a patient’s condition warrants, the neurologist expedites their transfer to a healthcare facility that can provide the higher level of care needed.
“You have a very narrow window of time to get that person’s condition under control by stopping the bleeding and controlling the swelling,” says vascular neurologist Nada El Husseini, MD, MHS, Duke Telestroke medical director. “Most community hospitals are not comfortable providing care to people with bleeding in their heads. Through our telestroke network, we work to diagnose and triage these patients and get them transferred in a timely fashion to a higher level of care.”
Expert stroke program development plan is a critical component to support expert physician consultations and patient stroke care at community hospitals. The program development team collaborates with the local hospital leaders to build a stroke program to manage the patient through the stroke continuum of care and meets the requirements for advanced stroke certifications.
Outcomes
Stroke patients’ care at partner hospitals has improved dramatically:
- Ischemic stroke patients receive tissue plasmogen activator (tPA) to dissolve the clot and prevent brain damage at a higher rate than the national average: “Nationally, 8% to 10% of all stroke patients get tPA,” says El Husseini. In the telestroke program, “the average tPA rates are around 15%.”
- Approximately 90% of patients seen in the telestroke program remain at their local hospital, near their homes and loved ones.
- One partner hospital reports 74% of their stroke patients can go home after discharge, compared with 35% of their stroke patients before joining the network.
- Of patients referred to Duke for advanced treatment, 65% now go home or to a short-term acute rehab facility upon discharge.
- 100% of telestroke sites have Advanced Stroke Certifications by The Joint Commission after being part of the Duke Telestroke Network for at least one year.
“These are good outcomes for people who present with severe stroke and who would have otherwise not had access to that level of care,” Dr. El Husseini says. “This is an exciting time in stroke care.”