The telestroke program at Penn State Hershey Medical Centers (PSHMC) has dramatically improved care for stroke victims and sets a high bar for other organizations looking to follow suit.
The five-year-old program, LionNet, contracts with 15 partner hospitals throughout South Central Pennsylvania to provide comprehensive telestroke services, enabling these mostly small, rural facilities to treat stroke patients faster, reduce transfer rates and decrease complications.
When PSHMC launched the program in 2012, its partner hospitals typically transferred about 80 percent of suspected acute stroke patients to Hershey. They either didn’t have the expertise or the bandwidth to treat them. The scenario is quite different today. Partner hospitals transfer only about 10 percent of these same patients from their emergency departments, thanks to the stroke-specific neurologists, neurosurgeons and nurses they can tap into via LionNet.
“Because the majority of their patients can now stay at these facilities, they get all of the DRG benefits,” says Raymond Reichwein, MD, LionNet’s medical director, who will present the program's strategies and results at the Telemed Leadership Forum 2018 in Washington, DC.
LionNet’s partner hospitals are also improving care. When the program began, barely one percent of their suspected acute ischemic stroke patients received IV tissue plasminogen activator (tPA), a clot-dissolving drug. Today, about 25 percent of patients at LionNet sites receive this life-saving treatment, Reichwein says. And they’re getting it faster.
Treatment times have decreased from about 90 minutes to less than 70 minutes—well within the recommended “door-to-needle” treatment window of 3 to 4.5 hours within onset of symptoms.
“They call us quickly, we interact quickly and many more patients get treated in an earlier fashion,” Reichwein says. “Many of our partners have limited or no access to acute stroke care. So, the access they now have is critical.”
PSHMC also benefits. Although the LionNet program has resulted in far fewer transferred stroke patients, those who are transferred require a higher level of care.
“It brings downstream revenue to our facility, either as direct result of the acute care treatment or subsequent follow-up visits that are necessary,” he says.
It also helps from an operational standpoint.
“We’re always running at 100% capacity, so we don’t want to bring on any additional patients if we don’t have to,” he says.
How it works
LionNet is a hub-and-spoke network that uses audio/visual capabilities to provide real-time neurological consults for suspected acute stroke patients within the EDs of its network of 15 regional hospitals.
Once the consult is complete, the hospital opts to either treat the patient with their own local neurologist or transfer the patient to another facility with more expertise—usually PSHMC.
What the future holds
Moving forward, PSHMC plans to seek telestroke contracts with health insurance companies and other types of organizations; develop a telestroke program for follow-up care and provide telestroke capabilities to first responders.
“In my business, ‘time is brain.’ Anything we can do to shave off a half-hour by hitting buttons and having a specialist available and helicopters waiting will be in the best interest of the patients.”