Improving Stroke Care in North Carolina:
The WFBH Telestroke Program
Charles H. Tegeler, MD
McKinney-Avant Professor of Ne...
Stroke Death Rates by County of
Residence, N.C., 2004-2008
WFBMC

Death Rate
35.5 - 43.5
43.6 – 51.8
51.9 – 60.0
60.1 – 71...
Thanks to Paige Bennett
Wake Forest Baptist Health

Kleindorfer et al, Stroke, 2009
Hospital Predictors of tPA Use
MEDPAR Database, N = 4626 hospitals

Small

South

Rural
Wake Forest Baptist Health

Kleind...
Telemedicine in Stroke:
What is the Evidence?

Stroke 2009;40: 2616-34
Wake Forest Baptist Health
WFBH Telestroke Services
Motivations and Goals
• Time limited window of opportunity – Time is brain

• Gaps in access to S...
WFBH Stroke Team
Vascular Neurology (5), Vascular Neurosurgery (2), Interventional
Neurosurgery/Neuroradiology (3), Stroke...
WFBH Telestroke Services
What did we end up with?
• 24/7 easy access to consultation with board-certified or
fellowship-tr...
WFBH Telestroke Services
Current Snapshot

• Initial Network Hospital signed - 11/09
• Initial Network Hospital live - 12/...
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
...
Patient Disposition When Robot Activated

Wake Forest Baptist Health
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 relati...
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

Wake Forest Baptist Health
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Improving Stroke Care in North Carolina: The WFBH Telestroke Program

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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

  1. 1. 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
  2. 2. Stroke Death Rates by County of Residence, N.C., 2004-2008 WFBMC 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 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.
  3. 3. Thanks to Paige Bennett
  4. 4. Wake Forest Baptist Health Kleindorfer et al, Stroke, 2009
  5. 5. Hospital Predictors of tPA Use MEDPAR Database, N = 4626 hospitals Small South Rural Wake Forest Baptist Health Kleindorfer et al, Stroke, 2009
  6. 6. Telemedicine in Stroke: What is the Evidence? Stroke 2009;40: 2616-34 Wake Forest Baptist Health
  7. 7. 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
  8. 8. 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 Wake Forest Baptist Health
  9. 9. 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 RP7 Remote Presence (In Touch Health) • If needed: Preferential bed placement with rapid and facilitated transfer with single “800” phone number
  10. 10. 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
  11. 11. Wake Forest Baptist Telestroke Network = WFBH = WF Telestroke Site = WF WIP Site Wake Forest Baptist Health
  12. 12. Telestroke Network Activity Wake Forest Baptist Health
  13. 13. 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%) 54 (47%) NA Transferred to WFBH Transferred elsewhere 20 (12%) 3 (3%) 17 (35%) # tPA 44 (27%) 32 (28%) 12 (25%) Wake Forest Baptist Health
  14. 14. Patient Disposition When Robot Activated Wake Forest Baptist Health
  15. 15. tPA Administrations Pre and Post Telestroke Network Participation
  16. 16. 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
  17. 17. Telestroke in North Carolina (October, 2010) Wake Forest Baptist Health
  18. 18. Telestroke in North Carolina (January, 2012) Wake Forest Baptist Health
  19. 19. Thank you for your attention Wake Forest Baptist Health
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