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