Duke Telestroke Network Improves Stroke Care, Patient Outcomes at 5 NC, VA Hospitals

By MaryAnn Fletcher
May 11, 2016

Patients at Duke Telestroke Network hospitals get the immediate care they need and, when necessary, are transferred faster to hospitals providing advanced procedures, which can make a life-or-death difference. Watch how it works below.

Immediate stroke treatment can prevent serious disability and death. Stroke treatment advances are equally important but aren’t offered at every hospital. Duke’s Telestroke Network gives patients and doctors at five NC and VA hospitals access to Duke stroke specialists 24/7. 

Duke neurologists do telestroke consultations at:

  • Maria Parham Medical Center, Henderson, NC
  • Nash General Hospital, Rocky Mount, NC
  • Wilson Medical Center, Wilson, NC
  • Danville Regional Medical Center, Danville, VA
  • Memorial Hospital of Martinsville, Martinsville, VA

Using a telestroke robot, Duke neurologists in Durham evaluate stroke patients in emergency rooms miles away via two-way telemedicine video conferencing. The neurologist uses the technology to consult with the patient, family and local ER caregivers and view the patient’s CT scans. When the patient’s condition warrants, the neurologist expedites his or her transfer to Duke University Hospital, Duke Raleigh Hospital or another hospital that can provide the needed care. By the time the patient arrives, the stroke team is assembled and ready to perform what could be a lifesaving procedure.

Program Leads to Better Stroke Care at Local Hospitals

Most strokes are ischemic strokes, meaning they are caused by blood clots that block the flow of blood to the brain. Tissue plasminogen activator (tPA) can dissolve the clot and prevent damage to the brain if it’s given within hours of the onset of stroke symptoms.

The hospitals in the Duke Telestroke Network have significantly increased the rates at which their patients receive tPA. “Nationally, 4 to 8 percent of all stroke patients get tPA,” said Duke neurologist Brad Kolls, MD, PhD. In the telestroke program, “we’re seeing tPA rates as high as 20 percent.”

Eighty-seven percent of patients seen in the telestroke program remain at their local hospital instead of being transferred to Duke or other centers. That’s a huge benefit, explained Kolls, director of the Duke Telestroke program, because patients can remain near their loved ones and familiar surroundings. That leaves more care teams and beds available at Duke for the 10 percent or so of patients who have extremely serious strokes and need advanced procedures.

Telestroke network demonstration at Danville Regional Medical Center
Telestroke network demonstration at Danville Regional Medical Center

Innovative Stroke Procedure Available at Duke

Some ischemic stroke patients need more than tPA. In those cases, studies show a relatively new procedure called thrombectomy may be the patient’s best hope to survive and to retain normal, healthy function. During the procedure, a neurosurgeon threads a small, flexible tube called a catheter through an artery in the leg to the brain. A wire cage-like device called a stent retriever at the end of the catheter snags the clot and pulls it out. This restores blood flow to the brain.

Over the past few years, several studies in the New England Journal of Medicine have reported that thrombectomy—with or without prior tPA—is better than tPA alone. “These studies found that the latest devices actually improved people’s recovery from stroke substantially,” Duke neurosurgeon Ali Zomorodi, MD, said. “We can do the same interventions for the brain that we do for the heart. If you treat stroke the same way you treat heart attack, you can restore people to an independent life.”

Thrombectomy is only performed at comprehensive stroke centers like Duke, where neurosurgeons like Zomorodi are trained in the complex procedure. Approximately 80 thrombectomies were performed at Duke last year; about one-quarter of those were transferred through the telestroke network, said Kolls.

Hemorrhagic strokes, caused by bleeding in the brain, are just as urgent. “If blood gets into the fluid-filled spaces of the brain, it can cause devastating neurologic injury and death,” said Kolls. A neurosurgeon may need to repair the cause of the bleeding or insert a drain to relieve pressure. “You have a very narrow window of time to get that person’s condition under control,” said Kolls. “Most community hospitals are just not comfortable providing care to people with bleeding in their heads. They are a population that needs to come to us.”

Duke neurologists view CT scans and discuss them with the patient via telemedicine.
Duke neurologists view CT scans and discuss them with the patient via telemedicine.

More Stroke Patients Go Home Healthier

The Duke Telestroke Network has made it possible for patients to fare better by ensuring they get the right care, in the right location, right away. One measure of its success is how many patients go directly home after treatment instead of to a nursing facility. Before the Duke Telestroke Network started, one partner hospital reported that 35 percent of stroke patients went home when they were discharged. After joining the Network, that number jumped to 74 percent. “We’ve nearly doubled their percent of patients being discharged to home,” Kolls said.

The doctors are also seeing good outcomes among patients transferred to Duke for advanced treatment: 60 percent now go home or to a short-term rehab facility. “Those are good outcomes for people who would have otherwise not had any access to that level of care,” Kolls said. “This is an exciting time in stroke care. The Duke Telestroke Network is just one of several across the state. Hopefully, the widespread use of telemedicine will result in improved care quality and outcomes for all North Carolinians who suffer a stroke.”

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Stroke Care at Duke