Kaiser Permanente's coordinated telemedicine response workflow slashes ‘door-to-needle’ time for stroke patients.
Telemedicine is at the heart of a complete workflow redesign of the way stroke alerts are handled across Kaiser Permanente's 21 Northern California hospitals, resulting in new stroke patients being treated twice as fast as the national average, according to a study.
American Heart Association and American Stroke Association guidelines recommend a "door-to-needle" time of 60 minutes or less for administering intravenous r-tPA, also known as alteplase, a drug that dissolves the stroke-causing clot and restores blood flow to the brain.
A study in the journal Stroke compared door-to-needle times for six months before implementation of the telemedicine program to a six-month calendar period after implementation. It showed that across the 21 hospitals, the average treatment time for intravenous r-tPA was 34 minutes. The study also showed that:
- 87% of stroke patients were treated in 60 minutes or less
- 73% were treated in 45 minutes or less
- 41% were treated in under 30 minutes
The Stroke EXPRESS (EXpediting the PRrocess of Evaluating and Stopping Stroke) program was redesigned in 2015 to help speed evaluation and treatment of patients, even though there aren’t enough stroke neurologists to go around all 21 centers, says Mai Nguyen-Huynh, MD, MAS, vascular neurologist and research scientist with the Kaiser Permanente Northern California Division of Research.
How it works
Nguyen-Huynh says her team asked itself, "How do we streamline our system to really expedite the evaluation of these stroke patients" to determine when patients aren’t having a hemorrhagic stroke and, therefore, are good candidates for intravenous r-tPA.
Although the system offered telemedicine for a couple of services, there was nothing standardized in place until the Stroke EXPRESS program.
"We found that the only way that we could really do this is standardize and centralize things," Nguyen-Huynh says. "There needs to be one system, one protocol."
Alexandra Wilson Pecci is an editor for HealthLeaders.