1. 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

2. 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).

3. 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.

4. 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 Beds
Doernbecher Children's Hospital Beds

5. 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

6. 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

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

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

9. 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.

10. 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

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

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

15. 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).

16. Continuum of care

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

18. Thank You any Questions?
Jean McCormick
Adrienne McDougal