The UC Davis teleneurology program’s telestroke service responds within 10 minutes to help community hospitals expedite key treatments.
When it comes to acute strokes, time lost is brain lost.
Thanks to advances in medical understanding, clot-busting drugs are now widely available to help reduce incapacitating brain damage in the most common types of stroke events. But they must be delivered within roughly 4.5 hours of onset — and the sooner they’re administered, the more damage they help prevent.
“We think about stroke in 30-minute increments — with every 30 minutes that can be shaved off the response time, there’s an associated decrease in morbidity and mortality,” said Kwan Ng, M.D., Ph.D., a fellowship-trained stroke neurologist who directs vascular neurology at UC Davis and leads its stroke center. “The most benefit from (clot busters) occurs in the first 30-, 60- and 90- minute intervals.”
So while time is precious in all stroke care, it’s especially precious at rural hospitals like Marshall Medical Center in the Sierra Foothills community of Placerville. The town of roughly 10,000 serves as a gateway to a significant chunk of the rural western Sierra Nevada, and patients coming to Marshall’s emergency room and Level III trauma center can arrive after long rides that chew into the crucial effectiveness window for blood thinners.
To help provide diagnostic and treatment expertise as quickly as possible upon arrival, Marshall and UC Davis partner on a contract telehealth program that offers rapid video consults for acute strokes and other neurologic emergencies, such as intracerebral and subarachnoid hemorrhages.
The telestroke program provides 24-7/365 on-call access to Ng or other UC Davis vascular neurologists within a 10-minute window, allowing them to help assess symptoms and confirm diagnoses via telemedicine. That helps on-site Marshall emergency teams decide whether and how best to administer the key clot-buster tissue plasminogen activator (tPA), and also gauge need for additional intervention such as mechanical thrombectomy, a catheter procedure used to manually break up a clot.
While Marshall is a certified primary stroke center, the arrangement with UC Davis allows the community hospital to avoid the financial and logistical burden of maintaining constant on-site subspecialty vascular or stroke neurology expertise. And if a patient is determined to benefit from a transfer to Sacramento for in-person treatment, the ongoing partnership helps to enhance predictability and continuity.
“Collaboration gives us the ability to quickly seek advice and consultation from physicians in a variety of specialties, and to offer treatments and services that may not be available in the community setting,” said Janice Weaver, R.N., B.S.N., a Marshall performance improvement and stroke specialist who works closely with the hospital’s stroke medical director, Rajiv Pathak, M.D. “Working with an academic hospital also allows for ongoing communication and sharing about best practices and it optimizes continuing education — things that further enhance our ability to provide high-quality care.”
UC Davis recently expanded telestroke to Adventist Health Lodi Memorial Medical Center as well, as part of ongoing efforts by the university’s neurology department to offer expert consultation throughout Northern California via web video, telephone or on-site visits. U.S. News & World Report ranked UC Davis 26th in the nation for adult neurology and neurosurgery in 2016–17.
The UC Davis teleneurology program also offers daytime non-emergent inpatient consultations for subacute stroke, seizures, intractable head pain and other acute situations via video link at San Joaquin General Hospital near Stockton and Shasta Regional Medical Center in Redding, and via telephone at San Joaquin. San Joaquin and Lodi also tap UC Davis for remote reads of routine EEG studies.