Jack Murtha

You’ve heard this before: Every minute counts during a stroke. Although the message is clear, paths to cut down clinical response times have been neither obvious nor easily navigable. But Kaiser Permanente appears to have mapped out a solution.In a study published today, the health system detailed the fruits of a program called Stroke EXPRESS, or Expediting the Process of Evaluating and Stopping Stroke. Through telemedicine, Kaiser Permanente reduced the time it takes to administer the clot-busting medication r-tPA, or alteplase, according to an announcement . It touted the findings as among the first peer-reviewed, published studies to outline how uniform treatment procedures and telemedicine, when properly implemented, can “dramatically” cut down the time it takes to begin treatment in “large, integrated” hospital groups.“Faster treatment with intravenous r-tPA, which dissolves the stroke-causing clot and restores blood flow to the brain, is strongly associated with better functional outcomes for stroke patients,” said the study’s lead author, Mai Nguyen-Huynh, MD, MAS, a vascular neurologist and researcher at Kaiser’s division of research.Industry guidelines call for “door-to-needle” times to be no more than 1 hour. Across the country’s healthcare system, less than 30% of acute ischemic patients receive treatment in that time frame. But Kaiser Permanente cared for 87% of patients within that critical window, treating 73% in 45 or fewer minutes and 41% in no more than 30 minutes. On average, the time it took to deliver r-tPA was just 34 minutes, according to the study.The study ran from September 2015 to January 2016, comparing 557 patients with 337 individuals who received stroke treatment in the 9 months prior to the launch of Stroke EXPRESS. Researchers found that the average treatment time dropped from 53.50 minutes, for an improvement of about 20 minutes, and they saw “no increase in adverse outcomes,” according to the study.So, how has this large healthcare system managed to do what few others have? Telemedicine—and the implementation of a modified Helsinki model to guide how it handles acute strokes throughout its 21 hospitals in Northern California. The Stroke EXPRESS program equipped emergency departments with “telestroke carts,” comprising a video camera and access to scans and test results, a toolkit that has empowered stroke specialists to conduct exams miles away from the patient, according to Kaiser Permanente.“Processes that used to happen sequentially during a stroke alert, one after another, are now happening at the same time, allowing us to quickly, safely, and confidently provide evaluation and treatment with intravenous r-tPA to stroke patients who can benefit,” said Jeffrey Klingman, MD, a study co-author and chair of chiefs of neurology for Kaiser Permanente’s Northern California arm.Here’s how it works: Paramedics alert the emergency department of a stroke patient’s pending arrival, prompting a stroke neurologist to meet with the patient, either in person or over a video stream. Pharmacists, meanwhile, ready the r-tPA for use after a radiologist confirms that a patient is a “good candidate” for the drug.The study, “Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System,” is available for review in the journal Stroke.