Is Telemedicine Still the Appropriate Resource for Triaging Stroke Transfers? Good morning Adrienne and I review telestroke data every month and as we review it, we look to see if there DATE: March 3,2016 PRESENTED BY: Jean McCormick, RN,MSN Clinical Nurse Educator telemedicine and Adrienne McDougal, RN, BSN, CCRN-K Stroke Program Coordinator

Objectives Discuss the current state of Stroke Telemedicine consults at OHSU reviewing 5 years of data. Discuss outcomes of appropriate stroke transfers including cost based savings for community, better enrollment in research studies, appropriate triage and treatment. Discuss the growth and outcome of consults in continuum of care ( e.g ambulatory follow ups, at home consults for research).

Welcome to OHSU Healthcare OHSU Healthcare Mission & Vision OHSU Mission Through innovation, education and clinical expertise, we provide the best possible healthcare experience for patients and their families. Talking Points. OHSU Hospitals and Clinics mission is Through innovation, education and clinical expertise, we provide the best possible health care experience for patients and their families.” OHSU Vision Help make Oregon a national leader in health and science innovation to improve the health and well being of all Oregonians.

Only Academic Medical Center in Oregon Integrated clinical research and education programs Graduate Medical Education School of Medicine School of Nursing School of Dentistry Physician Assistant program Highest patient acuity in Oregon and top 10 CMI in the US (UHC) OHSU Adult Hospital - 383 Beds Doernbecher Children's Hospital - 145 Beds

OHSU Facts GENERAL WORKLOAD STATISTICS FY14 Healthcare Employees: about 7,000 WORKLOAD STATISTICS FY14 Occupancy 84% Discharges: 28,477 (not including newborns) ALOS: 5.8 CMI: 1.97 Births: 2,517 Surgeries: 30,414 Practice Visits: 776,918 Emergency Visits: 45,611 Primary, Secondary and Tertiary Care for All Ages Acute care adult hospital (OHSU) Acute care children’s hospital (Doernbecher Children's Hospital) Ambulatory practices (primary and specialty) Veterans Administration Medical Center Affiliation Shriners Hospital for Children Affiliation Key Programs and Institutes: Emergency Services Knight Cancer Institute Casey Eye Institute Level 1 Trauma Center Knight Cardiovascular Institute Orthopedics Surgery Pediatrics (DCH) Neurosciences Transplant/OPO Center for Women’s Health

Telehealth Across the Continuum of Care As part of those services mentioned in previous slide, telemedicine plays an instrumental role in the service line. Here we have our channels First began in 2010 10 stroke sites

Acute Care Program began 2007 Expansion in 2010 PICU to Sacred Heart, Eugene Expansion in 2010 Service lines Stroke, PICU, NICU Genetics Psychiatry

Stroke care at OHSU The first Joint Commission Certified Comprehensive Stroke Center in the Pacific Northwest. Designation as of March 2013

What makes a Comprehensive Center different? Specific expertise in a number of disciplines, including neurosurgery and vascular neurology. Advanced neuroimaging capabilities, 24/7/365 Surgical and endovascular techniques Infrastructure and programmatic elements such as a dedicated neuro intensive care unit staffed with neurointensivists. Extensive data collection and peer review process Participation in stroke research.

Burden of Stroke 5th Leading Cause of death in the United States killing nearly 129,000 people per year 4th Leading cause of Death in Oregon Leading cause of Adult disability On average: A stroke occurs about 40 seconds and someone dies from stroke every 4 minutes Higher incidence in Women (60%) than men Strokeassociation.org Oregonhealthauthority.org

Case study 3 hours after symptom onset Blood was restored Telemedicine base vs. consult on timeline put in columns

Where are these patients coming from? More than 80% of our volume is from telemedicine consults 2015 Drip and Ship tPA cases = 82 cases

The “Drip and Keeps” Total Consults: 1161 Tele-Stroke: 824 Tele-Stroke kept 59% of patients local Define drip and keeps In fact 89% of those drip and keep are from Asante Rogue River in Medford a program which began in 2012 Talk about different cases that stay in community that don’t need to be at ohsu Discuss the growth and outcome of consults in continuum of care ( e.g ambulatory follow ups, at home consults for research).

Continuum of care

So Is Telemedicine still the appropriate resource for triaging stroke transfers?

Thank You any Questions? Jean McCormick mccormje@ohsu.edu Adrienne McDougal padillad@ohsu.edu