1. Mid America Stroke Network Founded By: Saint Louis University Hospital (SLU Hospital)

2. The Mission Mission: Elevate the Quality of Stroke Treatment Within Outlying Communities by Collaborating with Community Hospitals and Offering Our Tertiary-Level Stroke Capabilities and Knowledge Within Those Local Communities. Goal: Initiate a “Mid America Stroke Network” Utilizing a collaboration with SLUcare Physicians, Saint Louis University Hospital, and Multiple Community Hospitals. Objective: For Appropriate Patients, Administer Tissue Plasminogen Activator (t-PA) Within 180 Minutes of Symptom Onset, Obtain a CT of the Brain and Interpret Within 25 Minutes of Arrival, and Assist the Outlying Hospitals in Monitoring and Elevating The Joint Commissions Standard Stroke Measures.

3. The Spoke Hospital Candidates Will Show a Commitment to:  Stroke Services and Community Benefit  Quality Monitoring and Focus  The Necessary Supporting Resources Selected Candidate Hospital Will:  Embrace the American Stroke Association Protocols  Diagnose the Stroke Patient (ER or Neurology Physician)  Participate in a Dynamic Triage Process (Treat Internally within Capabilities, Transfer to SLU Hospital, or Transfer to Any Other Capable Hospital)  Evaluate Stroke Standard Measures/Indicators

4. The Hub Hospital SLUcare Physicians Will:  Respond Promptly to Consultation “Page”  Collaborate to Determine Best Treatment Outcome for the Patient  Request to View the Patient’s Physical Condition, Vital Assessment, and Images.  Discuss the Patient’s Response to t-PA Treatment SLU Hospital Will:  Select Committed Stroke Partners  Collaborate to Establish Industry Leading Stroke Protocols  Provide support as a Joint Commission Certified Stroke Center for a higher level of care if needed

5. 1 st Year Results Clinical Results  Stroke specialists at bedside in 10 to13 minutes  90 minute door to needle time  80% of eligible patients received IV t-PA  18 hospitals administered t-PA for the first time  33% transfer to Hub for advanced care  10% received interventional procedures  Average NIHSS scores  Admission = 10  Discharge = 3

6. The Transfer Process  Call SLU Hospital One Call Referral Number (1-866-491- 0858) when a stroke patient presents  State you have a stroke patient and need to speak to the stroke neurologist  The SLUCare Stroke Neurologist will consult with the community hospital physician and help assess the patient  Outside Hospital pushes the radiology images to SLUH once completed  Outside Hospital calls for transport service if appropriate

7. Candidates for Transfer Who should be considered for transfer: Any acute ischemic stroke patient presenting within 0-12 hours regardless of whether they have received IV tPA. If a patient has received IV tPA, the recommendation is not to wait to see if the patient improves. If the NIHSS ≥ 10, transfer consideration is recommended. What information do we need prior to transfer: Last time the patient was seen normal; non-contrast Head CT findings; NIHSS; pertinent labs (INR, creatinine, etc.); pertinent medical history if available; contact info of family to discuss treatment options (physician may be able to discuss with the family over the phone)

8. Illinois Member Hospitals Anderson Hospital Fayette County Hospital Franklin Hospital Good Samaritan Regional Health Center, Mt. Vernon Greenville Regional Hospital Heartland Regional Medical Center Herrin Hospital Memorial Hospital, Belleville Memorial Hospital, Carbondale Red Bud Regional Hospital Salem Township Hospital St. Elizabeth’s Hospital St. Joseph’s Hospital, Highland St. Joseph’s Memorial Hospital, Murphysboro St. Mary’s Hospital, Centralia Sparta Community Hospital Washington County Hospital

9. Missouri Member Hospitals Des Peres Hospital Forest Park Hospital Jefferson Regional Medical Center Lincoln County Memorial Hospital Mineral Area Regional Medical Center Perry County Memorial Hospital Pike County Memorial Hospital Popular Bluff Regional Medical Center Southeast Missouri Hospital Ste. Genevieve County Memorial Hospital Twin Rivers Regional Medical Center Washington County Memorial Hospital

10. The SLU Hospital Experience Patient Need for Tertiary-Quaternary Level of Care:  Dial 1-866-491-0858  Code Stroke Activated  Treatment Goals with High Validity and Reliability: Tissue Plasminogen Activator (t-PA) 180 Minutes within Symptom Onset CT within 25 minutes of Arrival Immediate House Placement Discharged Back to the Community is a Priority