Presentation by Charles Tegeler IV, MD, Wake Forest Baptist

1. Improving Stroke Care in North Carolina:
The WFBH Telestroke Program
Charles H. Tegeler, MD
McKinney-Avant Professor of Neurology
Director, Telestroke Services
Director, Ward A. Riley Ultrasound Center

2. Stroke Death Rates by County of
Residence, N.C., 2004-2008
WFBMC
Death Rate
35.5 - 43.5
43.6 – 51.8
51.9 – 60.0
60.1 – 71.5
71.6 – 98.9
N.C. overall: 54.4
U.S. (2002-06): 49.8
Stroke: ICD-10 codes I60-I69.
Rates per 100,000 population, age-adjusted to the 2000 U.S. standard population.
N.C. Data Source: N.C. Center for Health Statistics. North Carolina Vital Statistics, Volume 2: Leading Causes of Death, 2008. Raleigh, N.C.:
N.C. Dept of Health & Human Services; 2009. U.S. Data Source: Compressed Mortality File, CDC Wonder.

3. Thanks to Paige Bennett

4. Wake Forest Baptist Health
Kleindorfer et al, Stroke, 2009

5. Hospital Predictors of tPA Use
MEDPAR Database, N = 4626 hospitals
Small
South
Rural
Wake Forest Baptist Health
Kleindorfer et al, Stroke, 2009

6. Telemedicine in Stroke:
What is the Evidence?
Stroke 2009;40: 2616-34
Wake Forest Baptist Health

7. WFBH Telestroke Services
Motivations and Goals
• Time limited window of opportunity – Time is brain
• Gaps in access to Stroke Neurologists and to acute
stroke Rx, without waiting for transportation
• Program Goals/Objectives:
• Improve stroke care in region/state
• Increase access to, and use of, tPA
• Encourage local care, but facilitate appropriate
transfers who need higher levels of care
• Avoid unnecessary transfers
• Management Tool to enhance patient care
relationships between WFBH & network hospitals

8. WFBH Stroke Team
Vascular Neurology (5), Vascular Neurosurgery (2), Interventional
Neurosurgery/Neuroradiology (3), Stroke Coordinator, Stroke NP,
Forsyth County EMS, Administrative Staff
Dr. Jeff Craig
Dr. John Wilson
Dr. Charles Tegeler
Dr. David Lefkowitz
Dr. Rashid Janjua
Rayetta Johnson, RN, Christina Condon, NP, Dr. Cheryl Bushnell, Dr. Pat Reynolds, Col. Dan Ozimek
Not Shown: Dr. Pearse Morris, Mike Waid, Lindsay Filoseta
Wake Forest Baptist Health

9. WFBH Telestroke Services
What did we end up with?
• 24/7 easy access to consultation with board-certified or
fellowship-trained Vascular Neurology Stroke Faculty via RP7 Remote Presence (In Touch Health)
• If needed: Preferential bed placement with rapid and
facilitated transfer with single “800” phone number

10. WFBH Telestroke Services
Current Snapshot
• Initial Network Hospital signed - 11/09
• Initial Network Hospital live - 12/09
• Through 2/12 – 276 calls, 187 robot consults
• Currently 9 Network Hospitals:
Lexington Memorial
Wilkes Regional
Ashe Memorial
Allegheny Memorial
Caldwell Memorial
Carteret General
Davie County Hospital
Catawba Valley
Lake Norman Medical Center
Wake Forest Baptist Health

11. Wake Forest Baptist Telestroke Network
= WFBH
= WF Telestroke Site
= WF WIP Site
Wake Forest Baptist Health

12. Telestroke Network Activity
Wake Forest Baptist Health

13. Network Activity Summary
Accomplishing Our Goals
(12/31/11)
Network Total
Regional sites
Remote site
Total activations
246
161
85
Robot consults
163 (66%)
115 (72%)
48 (57%)
# Remained local
89 (55%)
58 (50%)
31 (65%)
54 (47%)
NA
Transferred to WFBH
Transferred elsewhere
20 (12%)
3 (3%)
17 (35%)
# tPA
44 (27%)
32 (28%)
12 (25%)
Wake Forest Baptist Health

14. Patient Disposition When Robot Activated
Wake Forest Baptist Health

15. tPA Administrations Pre and Post Telestroke Network Participation

16. Key Lessons Learned
• Telestroke requires a team effort
• Keep best patient care as first priority
• It’s all about relationships
• Get EMS on board even before contract signed
• Get financial issues settled up front
• Need to plan for ongoing in-service and education
• Consolidate/unify protocols between hospitals
• Share successes – feedback to hospital and EMS
• Network Users meeting/forum to share best practices

17. Telestroke in North Carolina (October, 2010)
Wake Forest Baptist Health

18. Telestroke in North Carolina (January, 2012)
Wake Forest Baptist Health

19. Thank you for your attention
Wake Forest Baptist Health