South Carolina lies in the middle of the “stroke belt,” a swath of southern states where mortality from America’s fifth-leading cause of death is at its highest. Yet in terms of medical care, it’s one of America’s worst neurology deserts: Its 160 neurologists serve around 5 million in population—more than 31,000 potential patients for every provider.
A few years back just 35% of the state’s citizens lived within a 30-minute drive of stroke care. The solution was a telestroke network, centered at the Medical University of South Carolina and extended now to nearly the whole state. Some 96% of South Carolinians, MUSC telehealth clinical coordinators Amanda James and Nancy Turner told HIMSS attendees Thursday, now live within a 60-minute drive of stroke care, and 72% within 30 minutes.
The network lets specialists connected by audio and video provide remote consultations and treatment recommendations for victims of suspected strokes at a network of rural and community hospitals and medical centers, and the state is working to incorporate EMS ambulances as well. The network also links to outpatient clinics for follow-up care, eliminating long-distance return visits for discharged patients (an average of more than 160 miles per patient). It now includes 28 partner sites and 15 primary stroke centers.
Program leaders worked to keep the technology affordable; the cost per ambulance is just $2,250. The first truck was outfitted in 2017; now there are 26 across six counties, all operating 24/7 every day of the year. CT scans and tPA wait for the hospital, but the advance look at the patients reduces door-to-needle times and helps expedite endovascular transfers. Planned expansion will outfit 21 additional ambulances across five more counties.
In a pilot of the EMS capability that encompassed 25 cases, EMS-initiated consults produced an average door-to-needle time of 23 minutes, vs. 40 for those initiated in the hospital. EMS activation also cut the average door-to-decision time from 33 minutes to 13.
The 28 partner sites have now enabled more than 18,000 consultations, and the 15 primary stroke centers more than 5,700. The outpatient clinics are a newer feature; the first came online in 2017, followed by two more last year. They’ve seen 73 patients to date. One clinic already has a two-month waiting list, so adding more is a priority. There’s also interest in expanding follow-up capabilities to the home.
Many of the initial challenges have been conquered, the speakers said, the keys being intensive hands-on training at the partner facilities; evidence-based practices to convince skeptics; and a dramatic reduction in transfers to assuage local hospitals wary of losing patients. Around-the-clock tech support is also essential. Celebrating “wins” helps keep enthusiasm high; the program regularly recognizes things like its best door-to-needle and fastest page-to-log-in times.