Hands-On Hospitalists Plus Telemedicine Improve Stroke Outcomes
Major Finding: A medical center diagnosed 75% more strokes using telemedicine, compared with the prior year before the technology was used. Previously, zero patients received timely TPA vs. 10 patients who received it under the telemedicine system.
Data Source: Outcomes of 240 stroke admissions in the South Fulton (Ga.) telemedicine stroke center, compared with outcomes of more than 356,000 patients listed in the American Stroke Association "Get With the Guidelines" database.
Disclosures: Dr. Godamunne is vice-president of clinical systems integration for Eagle Hospital Physicians.
FROM THE ANNUAL MEETING OF THE SOCIETY FOR HOSPITAL MEDICINE
Ten patients qualified for tissue plasminogen activator treatment, with TPA given up to 4.5 hours past the last known time of being well. Dr. Godamunne noted that in the prior 2 years, no stroke patients admitted to South Fulton received TPA.
The increase in diagnoses, coupled with demographic factors, speaks to the enormous health problem in the South Fulton community, Dr. Godamunne said: 80% of the patients treated at the new stroke center were black – a known high-risk group for stroke.
"The need for acute and preventive stroke care was not being met in this community of 500,000, in part because patients had to travel an additional 30-45 minutes to a stroke center. In my hospitalist group, stroke was not even in the top 20 of our diagnoses – now it’s number 4, and the impact on us and the hospital has been huge."
In the comparison, mortality was slightly – but not significantly – lower at South Fulton (3% vs. 7%). "This was probably because we did not admit patients with intracranial hemorrhage," Dr. Godamunne noted. Patients presenting with suspected intracranial bleeding were taken to a sister hospital with constant neurosurgical capability.
Among the primary stroke care core measures, South Fulton stacked up well, matching or exceeding the aggregate in all eight measures, with no statistically significant differences.
The experience shows that a hospitalist can build and lead a stroke center, Dr. Godamunne said.
"Patients who were at a higher risk for stroke based on race and demographics can realize the benefits of thrombolytics and all the long-term preventive benefits of meeting all other stroke center guidelines."
