2015 conference power point

1. Memorial University Medical Center
Memorial Stroke and Telestroke Manager:
Jessica B Aspinwall, RN, BSN

2. Memorial University Medical Center (MUMC)
• MUMC, founded in 1955, is a nonprofit, two-state healthcare
organization serving a 35-county area in southeast Georgia and southern
South Carolina.
• 654-bed tertiary care hospital
• Regional referral center for cardiac care, cancer care, trauma, pediatrics,
high-risk obstetrics, and neonatology.
• Region's only Level 1 trauma center, children’s hospital and houses the
Savannah campus of Mercer University School of Medicine.
• One of the largest employers in the region, with approximately 4,500 Team
Members
• In 2014: 25,666 admissions. 235,699 outpatient visits. Performed 21,327
surgeries. Delivered 2,765 babies. 95,243 emergency department visits.
Average daily census 457. Average LOS 6.09 days.

3. Memorial Stroke Accolades
Memorial University Medical Center Awarded
•Disease Specific Certification as a Primary Stroke Center by TJC
• Re-certified in February 2015
•Received American Heart Association/American Stroke Association’s Get
With The Guidelines-Gold Plus Quality Achievement Award for 2012, 2013
and 2014.
• This award recognizes Memorial’s commitment and success in implementing a
higher standard of stroke care by ensuring that stroke patients receive
treatment according to nationally accepted standards and recommendations.
•Target:Stroke Honor Roll
• Recognizes Memorial for treating at least 50 percent of eligible ischemic
stroke patients with tissue plasminogen activator, or tPA, within 60 minutes of
arriving at the hospital (known as ‘door-to-needle’ time).

4. Stroke Facts
• Stroke is a “brain attack,” cutting off vital blood flow and oxygen to
the brain
• Fifth leading cause of death (killing over 133,000 people each year)
and the # 1 cause of serious, long-term adult disability
• Approximately 795,000 strokes occur each year
• One occurring every 40 seconds & taking a life approximately every 4
minutes
• 87% Ischemic & 13% Hemorrhagic
• MH: 76% Ischemic & 23% Hemorrhagic
• Two million brain cells die every minute during stroke
• Women are TWICE as likely to die from stroke than breast cancer
annually
• Time Is Brain.

5. MUMC is an academic medical
center that serves a 35-county area
in southeast Georgia and southern
South Carolina
Who we serve?
Berkeley
Charleston
Colleton
Beaufort
Orangeburg
Bamberg
Aiken
Polk
Haralson
Carroll
Heard
Troup
Harris
Muscogee
Crawford
Stewart
Quitman
Clay
Early
Seminole
Miller
Baker
Calhoun
Lee
Dooly
Crisp
Houston
Jones
Bibb
Washington
Hancock
Greene
De Kalb
Henry
Palding
Talbot
Upson
Laurens
Johnson
Emanuel
Candler
Bryan Chatham
Effingham
Screven
Burke
Richmond
Columbia
Appling
Wayne
Camden
Glynn
McIntosh
Pierce
Ware
Clinch
Echols
Lowndes
Brooks
Colquitt
Worth
Irwin
Ben Hill
Telfair
Dodge
Montgomery
Coffee
Atkinson
Grady
Barnwell
Hampton
Allendale
Dorchester
Cobb
Fulton
WilkesOconee
Walton
Newton
RockdaleDouglas
Monroe
Coweta
Fayette
Clayton
LamarPikeMeriwether
Jasper
Spalding
Butts
Taliaferro
Morgan
Warren
McDuffie
Putnam Glascock
Jefferson
Jenki
ns
Bulloch
Twiggs
Wilkinson
Baldwin
Bacon
Brantley
Charlton
Thomas
Decatur
Toombs Tattnall
Evans
Long
Liberty
Bleckley
Pulaski
Wilcox
Jeff Davis
Wheeler
Sumter
Schley
Taylor
Macon
Peach
Dougherty
Terrell
Randolph
Webster
Chattahoochee
Marion
Lanier
Berrien
CookMitchell
Treutlen
Turner
Tift
Jasper
>100
30-
100
5-29
<5
Trendstar Data: Jan 2013- Dec 2014

6. Stroke Population: Medical History
*Data: Outcome Science 2013 - 2014

7. Memorial’s Stroke Patient Population
*Data: Outcome Science 2013-2014
49% Female 51% Male

8. Memorial’s Stroke Patient Population
*Data: Outcome Science 2013-2014
59% Caucasian 40% African American

9. Stroke Patient: Mode of Arrival
*Data: Outcome Science 2013 - 2014

10. MUMC’s TeleStroke Program
• Web-based, telemedicine system
• Combining real-time audio and video conferencing between hospitals
• This allows the neurologist to evaluate the patient, perform a neurological
assessment, view the computed tomography (CT) scan, lab values, make a
diagnosis and initiate treatment from virtually anywhere.
• “Go-Live” 2Q 2011
• Bacon County Hospital Alma, GA (2011)
• Jeff Davis Hospital Hazlehurst, GA (2011)
• Meadows Regional Medical Center Vidalia, GA (2012)
• Liberty Regional Medical Center Hinesville, GA (2014)
• MH’s Emergency Department
• Partnership with Savannah Neurology Specialists
• 9 local neurologists provide an on-site neurology Monday-Friday 7a-5p

11. Tissue Plasminogen Activator (tPA)
• TPA is administered via IV and works by dissolving the clot and
improving blood flow to the part of the brain being deprived.
• Called: thrombolytic agent or a “clot buster”
• Only FDA approved drug treatment for acute ischemic stroke (1996)
• Treatment window – 3 to 4.5 hours since onset of symptoms
• If given promptly, 1 in 3 patients resolve symptoms or have major
improvement in stroke symptoms.
• Risk: bleeding (hemorrhage) in brain or other parts of the body (6 out of
100 patients)

12. Emergency Department Acute
Stroke Treatment: Code Stroke
MUMC 2014:
Median DTCT: 14 minutes
Median DTN: 54.5 minutes

13. Spoke Site: Acute Stroke Treatment

14. Telestroke Transfers
• Spoke Sites
• Administer TPA in ED
• Patient transferred to MUMC for higher level of care
• Flight→ Transport after 1st
set of 15 minute vitals & neuro check
complete- ED MD evaluates patient prior to transport
• Ground→ Transport after 1 hour infusion in complete

15. TPA Data: Age & Gender
Data: Outcome Science 2014
Median Age: Female: 66 Male: 57.5
Female: 41.9% Male: 58.1%

16. TPA Data: Diagnosis & Gender
Data: Outcome Science 2014
DTN <60 min: 61.9% of patients
TPA All Patients LOS: 4.94 days

17. TPA Data: Race & Gender
Data: Outcome Science 2014
67% Caucasian 30% African American

18. TPA Data: Discharge Disposition
Data: Outcome Science 2014
MUMC: 4.2% Mortality & 1.8% post TPA Complications

19. TeleStroke Utilization
*Memorial’s Emergency Department is included in regional spoke sites*
Year
# of regional
spoke sites
# of acute
neurological
consults
# of patients
treated with
IV-tPA via
telemedicine
% of patients
treated with
IV-tPA via
telemedicine
Total # of
patients
treated with
IV-tPA at
MUMC
2011
3 14 2 14% 31
2012
5 33 19 58% 65
2013
5 43 21 49% 72
2014
5 59 33 56% 85
2015
(YTDMarch) 5 13 8 62% 23

20. Benefits of Memorial’s TeleStroke
Program
• Builds regional relationships
• Promotes collaboration between clinical teams
• Decreased travel time and expenses for patients (decrease unnecessary
transfers)
• One call for seamless patient transfer (Transfer Center)
• Access to local neurological expertise
• Enables remote consultations
• Decreased response time in acute stroke (DTN)
• Increase the number of eligible patients who receive IV-tPA
or other time sensitive interventions
• Improve patient outcomes, decrease stroke related
disability, and reduce health care cost
• High patient and family satisfaction survey scores

21. Questions?