When a patient has a stroke, time is brain, as the saying goes.
In an effort to improve a patient's function and recovery after a stroke, Kaiser Permanente of Northern California redesigned treatment protocols in a program it dubbed Stroke EXPRESS, with EXPRESS standing for EXpediting the PRocess of Evaluating and Stopping Stroke. Key to its success were telemedicine, specialized treatment and a standardized approach, which led to faster diagnosis and treatment.
“We removed a lot of steps that used to happen in series,” said Dr. Jeff Klingman, the chief of neurology at The Permanente Medical Group and who helped develop the program. “Instead, we do a lot of things in parallel.”
Every year, more than 795,000 people have strokes in the U.S. About 130,000 of them die, making strokes the fifth-leading cause of death among Americans. Strokes cost about $33 billion every year, according to the Centers for Disease Control and Prevention.
The Stroke EXPRESS program addresses the long-standing challenge of reducing lag time in treating strokes.
For example, emergency medical services begin transporting to the hospital a man whose face is drooping and who can't speak. They call ahead to the emergency room and say they might have a stroke victim. The nurse who takes the call dials an on-call teleneurologist who connects with the local telemedicine robot and opens the incoming patient's chart, provided paramedics are able to identify him and his chart is accessible to the Kaiser network.
Once at the ER, a physician begins a clinical assessment along with a stroke neurologist, who observes and participates via the robot's high-quality audio and video. The goal is to assess the patient in five to 10 minutes.
If they determine that the patient is having an acute stroke, the team orders alteplase, a medication that dissolves clots. The pharmacy mixes the medication as the team wheels the patient down to a CT scanner. If they suspect the stroke is caused by a clot in a large blood vessel, they also order a critical-care ambulance to arrive at the emergency department, just in case.