Time is Brain: Kaiser Permanente Southern California Revamps Telestroke Program for Extended Thrombectomy Treatment Window

April 14, 2019 | 2:45 p.m. – 3:30 p.m. CDT

When it comes to treating stroke patients, intervention evidence and treatment guidelines are rapidly changing; Cleveland Clinic unveiled the “Expanded Window for Acute Stroke Intervention” as a Top 10 Medical Innovation for 2019. Additionally, many hospitals do not have neurologists physically on-call 24/7 to provide assessments and order lifesaving medication. This presents an opportunity to quickly activate interdependence networks via video modalities, truly “Telehealth In Action.”

This session walks through a large-scale implementation covering pitfalls and best practices alike.

1. We will review the Telestroke program, such as historical data, quality metrics and why immediate updates were necessary. KP SCAL implemented a 24/7 Telestroke Program in 2014, whereby neurologists video-in to hospitals through a telepresence cart. The program required a revamp to incorporate the newest 2018 AHA/ASA Guidelines for Acute Ischemic Stroke, reflecting an extended window for potential thrombectomy candidates of up to 24 hours. We created a system and named it “CODE 24.” Operationalizing the new guidelines meant taking care of more patients with the same number of resources.
2. As part of the session, we will walk through the implementation of PDSA cycle. Planning: A Regional Telestroke lead reviewed multiple processes and methodologies. Do: Brought the vision to executive leadership and telehealth operations team. Created workflows, training materials, resource guides, conducted a technology review and went on a roadshow with a Continuing Medical Education embedded presentation to educate all Emergency Department physicians. Study: Iterative process, learned from the first two sites. Act: Constant improvements based on hospital-specific feedback.
3. To highlight the impact, we will review cases and outcomes.
4. Lastly, we will discuss how this work is ongoing and we continue to integrate new guidelines from clinical studies, while not disrupting systems. We will emphasize the importance of learning from other Telestroke programs and sharing best practices.

Speakers:

• Navdeep Sangha, MD, Vascular Neurologist, Regional Stroke and Telestroke lead, Kaiser Permanente
• Jazmine Gutierrez, MPH, Regional Telehealth Consultant, Kaiser Permanente
• Amanda Hauser DeHaven, MPH, Regional Director of Strategic Projects, Kaiser Permanente