Hospitals across the country are looking to TeleStroke services to improve patient recovery after a stroke. When treating stroke patients, door-to-needle time is a critical factor; “time equals brain.” All hospitals want to shorten this critical span of time, but for rural hospital’s this is a much more difficult challenge. For hospitals looking for a sustainable solution to provide stroke care for their community, telemedicine is essential, creating the opportunity for immediate access to a highly experienced neurologist, who can examine the patient and offer treatment recommendations – well within the 60-minute standard set by Joint Commission.
A TeleNeurologist can make the critical decision whether your hospital can treat a patient on-site – or if they require tertiary care, greatly expediting the transfer process when necessary. TeleNeurologists collaborate with local EMS and hospital ED teams to prepare for incoming patients so they receive treatment quickly, as every minute counts.
In these four cases, it’s evident just how valuable TeleStroke service and coverage is – providing small rural, community and inner-city hospitals with access to expert neurologists at a moment’s notice and improving metrics in a number of ways.
Time is brain. I take a quick history and I do a physical exam and a stroke scale. I review the imaging and other relevant laboratory data. I talk to the patient or with a family member. If the patient meets the criteria for stroke intervention, we [on-site staff and TeleNeurologists] administer medication or request further testing or imaging. The main point is that I am available immediately because time is brain.
– Arum Sherma, TeleNeurologist & Board-Certified Psychiatrist & Neurologist
1. Great River Medical Center: Reduces Transfers with TeleStroke Services
Great River’s sole neurologist carried a full patient load – providing coverage during day shifts and on-call most nights and weekends. This schedule was taking a toll; the neurologist was close to burnout. When the neurologist wasn’t available, the hospital went without neurology coverage – which meant stroke patients were often transferred to a tertiary center 75 miles away.
Hospital leaders did the math, and found it was financially cost-effective to implement a TeleNeurology program that had the capability to greatly improve patient care as well as support their on-site neurologist.
- The hospital opted for a coverage model that includes access to daily scheduled consults, so more stroke patients could be treated at their local hospital, instead of being transferred.
- Great River’s on-site staff can now treat 100% of patients that don’t require tertiary care, guided by the Eagle TeleNeurologist.
While the on-site neurologist and a key nurse were hesitant at first, once they saw the remote consults in action, they were sold on the benefits of this service. Patients have adjusted as well, and appreciate being seen by a specialist so quickly and close to home.
This very positive experience with Eagle Telemedicine has resulted in a great partnership with the hospital, who implemented coverage in three more telespecialties after their success with the TeleStroke services program.
2. Rural Kentucky Hospital: On-Site Staff Support
After having previous success with Eagle’s TeleHospitalist program for night coverage, the hospital was interested in increasing access to specialty care for their patients with a TeleStroke program. Very quickly, Eagle supplied the hospital with a team of board-certified neurologists ready to support the hospital’s clinical staff.
Eagle neurologists are available within 2 minutes of every request, and “beam in” to the telemedicine cart, equipped with 2-way audiovisual videoconferencing technology to assess the patient within 10 minutes. Stroke consults include going through the National Institutes of Health (NIH) stroke scale, with the remote provider showing patients the NIH cue cards through the monitor on the cart.
- Providing support for on-site staff, the Eagle TeleNeurologist participates in the entire patient exam and gives an expert diagnosis within minutes.
- Neurology patient transfers were cut in half – reduced from 10 to 5 per month, allowing patients and families to stay in their community hospital, close to home.
- Hospital revenue increased; with an extra 5 neurology patients per month treated “in house”, the hospital’s ROI has been bolstered significantly — an extra $500k revenue annually, which easily covers the telemedicine costs.
In addition, the Director and Chief Nursing Officer have seen improvements in nursing staff’s diagnostic abilities and response times.
How to Stem the Tide of Transfers from Rural Hospitals
Rural hospital leaders are raising legitimate concerns rural hospital transfers. Rural hospital patient transfer have a tremendous impact on a hospital’s bottom-line, and creates challenges for the patient and the patient’s family. These hospital leaders want to stop the outflow of patients, or “out-migration”.
Though we have helped many hospitals solve this problem over the years, a rising tide of hospitals has come to us recently with the same problem—only this time with more urgency. Calls come in frequently, and the question is always the same: “Can telemedicine help us?”
3. HSHS St. Nicholas Hospital: Reduces Door-to-Needle Time with TeleStroke Services
This small-town Wisconsin hospital was certified by the Joint Commission in 2014 as a Certified Primary Care Stroke Center, and leadership knew the stroke program must perform at top levels to maintain their certification.
A common scenario – their neurologist was also on-call 24x7x365. The hospital wanted to provide him with much-needed backup support. HSHS increased support for their on-site provider with a TeleNeurology services, a Virtual Partnership coverage model with the remote neurologist sharing responsibilities with the local neurologist.
- Door-to-needle time dropped from 90 minutes to 52 minutes.
- Alteplase treatments more than doubled, from 7 to 15, on average.
- Stroke consults increased from 3 consults (the first month) to 12 cases monthly, on average.
- Average response from TeleStroke service is 3-4 minutes, unprecedented for this hospital and facilitating time-sensitive treatment with clot-busting tPA for eligible patients.
The hospital’s ED team gave very positive feedback about the TeleNeurologist the TeleStroke program overall. In addition, telemedicine has promoted new focus on workflow improvements and education – including a collaboration with local EMS teams, aimed at accelerating pre-arrival notification.
Working closely with EMS teams allows both the TeleStroke provider and on-site hospital team to prepare for arrival of a suspected stroke patient. This innovative program gained recognition from the Wisconsin Paul Coverdell National Acute Stroke Program by achieving a 20-minute decrease in door-to-CT-scan time – one of the highest reductions in Wisconsin.
4. INTEGRIS Bass Baptist Health Center: Reduced Locums Use and ALOS
This rural hospital was unable to provide consistent neurology care without the help of locum tenens specialists. Patients had to transfer to Tulsa or Oklahoma City, each 100 miles away. Locum specialists were a high-cost, unsustainable resource that drained hospital finances.
The hospital turned to Eagle Telemedicine. Eagle’s stroke telemedicine program has greatly improved patient care and reduced neurology locum support costs.
- Reduced unnecessary transfers of stroke/acute neurology patients with access to 24/7 coverage.
- Reduced stroke patients length-of-stay by 1.2-days, average.
- Reduced locums costs by $200,000+ annually.
- Increased hospital’s annual revenues $55,000+ with the ability to treat more patients on-site.
Does your hospital provide timely stroke care?
A community’s infrastructure depends on a hospital that can deliver essential healthcare in emergencies. The country’s obesity epidemic, along with an aging population, greatly increases risk of stroke in every region. Eagle’s TeleStroke coverage is designed to ensure that every patient gets the specialist care they need, in a very timely manner, to achieve an optimal outcome.
If your patients are waiting too long to see a neurologist, it’s time to discuss TeleStroke services. Neurologists are available – days, nights, weekends – to see your stroke patients at a moment’s notice. You’ll get highly experienced neurologists who can expertly diagnose the patient within minutes, documenting every symptom directly in your hospital’s EMR, prescribing optimal treatment that can be delivered on-site. Research shows – increased revenue from inpatient care very often pays for the cost of Eagle’s services.
