Pairing telestroke technology with providers who have advanced training and an unusual breadth of experience, WellSpan Health’s four Joint Commission-certified Primary Stroke Centers expedite lifesaving, 24/7 care to patients across York, Adams, Lancaster and Lebanon counties.
Thanks to increased awareness and improved technologies, stroke has fallen from the third- to the fifth-leading cause of death in the United States, according to the CDC. Yet it still strikes 800,000 Americans annually, with one death every four minutes.
Fortunately, many deaths and disabilities that result from stroke are avoidable with appropriate, rapid treatment — highlighting the importance of WellSpan Health’s dual emphasis on quality and speed in delivering care. Underscoring that commitment is the Primary Stroke Center certification that WellSpan York Hospital, WellSpan Gettysburg Hospital, WellSpan Ephrata Community Hospital and WellSpan Good Samaritan Hospital have earned.
“As Primary Stroke Centers, these acute care hospitals have undergone rigorous assessments,” says John Mingle, MD, Medical Director of the Stroke Program for WellSpan Health. “The Joint Commission evaluates the hospitals’ policies and procedures for stroke care to ensure we’re meeting its stringent criteria.”
“Telemedicine offers an opportunity for smaller regional hospitals to have access to leading experts in stroke care. This support is imperative for properly evaluating patients and producing the best possible outcomes.”
— Catherine Spahr, RN, Stroke Program Director, WellSpan Health
The certification process, which involves site visits by The Joint Commission, evaluates the facilities’ stroke programs against a series of metrics regarding coordination, standardization and quality of treatment. It also provides a framework for the structure and management of the programs.
“By achieving these benchmarks, we reduce inconsistencies in clinical processes, which improves the quality of patient care,” says Catherine Spahr, RN, Stroke Program Director for WellSpan Health. “In addition, the analysis of our processes by an outside organization provides objective feedback that we use for continuous improvement.”
Technology guided by experienced clinicians is crucial to stroke care at WellSpan Health. WellSpan utilizes telestroke audiovisual capabilities to bring the expertise of highly trained stroke specialists to patients throughout its largely rural catchment area. With 2 million brain cells lost every minute that passes following a stroke, the ability to remotely examine patients and their CT scans in detail within seconds can easily be the difference between life and death.
Telestroke makes it easy for emergency department physicians to consult with neurologists through Skype-like technology. The physicians can consult about a patient’s condition and determine the next steps that should be taken.
“This gives our specialists access to a patient regardless of the hospital location where he or she is receiving treatment so that we can expeditiously determine the next steps that should be taken,” Dr. Mingle says. “The technology is amazing. I can literally see patients’ eye color and what their pupils are doing. Without those capabilities, patients wouldn’t get the same level of care.”
Treatment frequently includes tissue plasminogen activator (tPA), the gold standard for quickly dissolving clots during an ischemic stroke. tPA is administered after consultations between emergency department physicians and remote neurologists. When tPA is indicated, the goal is to administer it within 60 minutes from the time the patient enters the hospital. However, it is not always the best course of treatment, and telestroke technology ensures that the appropriate specialists weigh in on that decision.
Patients who need more advanced care can be transported to WellSpan York Hospital by helicopter if necessary. That is the only facility in York, Adams and Lancaster counties with neuroendovascular interventional capabilities and one of the only sites in the region that offer mechanical thrombectomy, a minimally invasive procedure that uses a stent retrieval device to remove clots from the brain. Those factors have helped make WellSpan York Hospital a regional referral center for stroke treatment.
“Telemedicine ensures that patients who can benefit from more advanced imaging and interventions are transferred, while allowing patients who don’t need that additional level of care to receive treatment in their community,” Spahr says. “We don’t want to transfer people unnecessarily.”
Patients who have experienced a stroke can receive multidisciplinary, inpatient rehabilitative care at WellSpan Surgery & Rehabilitation Hospital in York County in order to reach the highest level of restored function, Dr. Mingle says. A full-time physician and a team of therapists trained in post-stroke rehabilitation customize treatment in areas such as lifestyle changes, speech and language, and balance and mobility.
Following discharge, WellSpan Rehabilitation provides outpatient services at multiple sites across the region, and WellSpan VNA Home Care helps patients work toward greater function in the context of their home environments.
Reinforcing the Stroke Program’s dedication to high-level care is WellSpan’s broader commitment to ensuring the program has the staff and technologies necessary to produce optimal outcomes for patients. Among other things, that includes the hiring of fellowship-trained neuroendovascular surgeons at WellSpan York Hospital, as well as providing the financial resources to ensure clinicians have access to state-of-the-art equipment.
“The health system has come together to make stroke care one of its top priorities,” Dr. Mingle says. “We have brought on leading experts and incorporated advanced technology, and we have set up lab, pharmacy and emergency department protocols to streamline stroke treatment. That signals a commitment on the part of WellSpan’s leadership to provide outstanding care to patients throughout the region.”
“Any need that a stroke patient would have can be provided within the WellSpan system,” Spahr adds. “There is not one service a patient would have to go outside of the system to receive.”
For additional information, visit WellSpan.org/Stroke.