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Dr. kiely fpt 2014 without notes
- 2. The Reality of Telestroke: Real People, Real Results James M. Kiely, MD, PhD CIO; AcuteCare Telemedicine 2014 Florida Telehealth Summit “Connect to Quality”
- 3. “Hub & Spoke” • Hub: Resources • Spoke: Need • Telestroke Provider: • “The axle that turns the hub and spoke” • Why? Stroke vs Neurologists • Outcomes… not just about technology!
- 4. What is Stroke? • Ischemic Stroke • clot or plaque blocks blood flow and starves brain cells of oxygen • 87% of strokes are ischemic • Symptoms: • sudden weakness, numbness, blindness or loss of speech • Think “F.A.S.T” – Time is Brain!
- 5. Stroke Facts in the U. S. • 795,000 Americans suffer strokes each year • 134,000 deaths each year • 3rd leading cause of death • 6,400,000 stroke survivors • #1 cause of serious, long-term disability Circulation 129:399-410, 2014 “Connect to Quality”
- 6. Stroke Belt “Connect to Quality”
- 8. Where are the Neurologists? • National crisis of availability; primarily rural • Neurology 10:1212, April 2013 • Need minimum 2 for 24/7/365 • Lack of responsiveness • Lack of comfort with tPA
- 9. A Brief History of Telestroke • 1954 Harrison’s Textbook of Medicine: • “There is no satisfactory medical treatment...” • 1995 NEJM: • Intravenous tPA effective within 3 hours • 2009 AHA/ASA Endorse Telestroke • Reduces barriers to acceptance • 12 Regional Telehealth Resource Centers (TRC) • Created to facilitate telemedicine in rural areas
- 10. Telestroke Results • 30% improved at 3 months • Time is Brain • 1.9 million brain cells every minute • tPA 3 Hour Window • 4.5 hours select cases • Door to Needle • “Golden Hour”
- 11. Telestroke Benefits Beyond Thrombolysis Cerebrovasc Dis 2009;27 (Suppl. 4):21-27 • Fewer unnecessary patient transfers • Higher volume of care leads to better outcomes • Higher satisfaction of medical staff • Stroke Mimics • Thrombectomy
- 12. Real Results: Stroke Mimics • J.B. 76 yo presenting with left hemiparesis • ICH; no tPA, thrombectomy? • Cortical signs: head and gaze deviation • Remote presence: deviation to left, clonic movement, Jacksonian March • Wife recalls more history • Admitted with Status Epilepticus • D/C to Rehab after 1 week
- 13. Real Results: Thrombectomy • D.S. 68yo “Wake Up Stroke” • Aphasic, Hemiplegic • Unknown time of onset • Marcus Stroke Center: Perfusion Defect • Puncture by 33 min, Retrieval by 29 min • Recovery @ 2 Hrs
- 16. Real People, Real Results Implementing a Successful Program “Connect to Quality” 16 Successful Relationships Require Strategic Goal Alignment Real People Working Together for Real Results
- 17. The Reality of Telestroke: Real People, Real Results James M. Kiely, MD, PhD CIO; AcuteCare Telemedicine 2014 Florida Telehealth Summit “Connect to Quality”