Written by The Business Journal Staff
Stroke patients have been receiving clot-busting medication at more than twice the speed of the national average in Kaiser Permanente hospitals in Northern California.
According to findings published last Friday in the journal “Stroke,” this follows the region-wide adoption of an integrated telemedicine program. It is among the first peer-reviewed and published studies to show how the successful implementation of standardized treatment protocols and telemedicine for acute ischemic stroke can reduce treatment time.
This faster treatment is aided by the EXpediting the PRocess of Evaluating and Stopping Stroke (EXPRESS) program. With this program, all of Kaiser Permanente’s Northern California hospitals have cameras and access to scans and test results, allowing stroke specialists to treat their patients from many miles away.
“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 co-author Dr. Jeffrey Kingman, chair of chiefs of neurology for Kaiser Permanente Northern California.
Currently, the only medication approved of by the United States Food and Drug administration to treat acute ischemic stroke in intravenous r-tPA.
“When a stroke happens, minutes matter,” said Dr. Mai Nguyen-Huynh, the lead author. “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.”
With EXPRESS, stroke team members execute tasks in tandem, with paramedics providing advance notification to the emergency department that they are bringing a stroke patient. The stroke neurologist is notified by a “stroke alert” and meets the patient on arrival — in person or on video — to coordinate the alert. Pharmacists prepare the medicine early to be administered once the radiologist confirms the stroke.
Studies have shown that less than 30 percent of acute ischemic patients in the country are being treated within the 60-minute window recommended by the American Stroke Association and American Heart Association. However, in Kaiser Permanente’s 21 hospitals in Northern California, 87 percent of stroke patients were treated in 60 minutes or less, while 73 percent in 45 minutes or less and 41 percent received treatment with 30 minutes.
Stroke EXPRESS was introduced to all Kaiser Permanente hospitals in Northern California between September 2015 and January 2016. The researchers compared Kaiser Permanente members treated with intravenous r-tPA in the nine months before implementation (337 patients) with those treated in the nine months afterward (557 patients).