Why TeleSpecialists uses SAVES to identify strokes versus FAST 

The FAST stroke screen (Facial drooping, Arm weakness, Speech difficulty, Time to call) was developed as a method of streamlining the triage of patients to determine if they have had a stroke. While this is a good start to identifying acute stroke symptoms, evidence has suggested that there are situations when a patient needs a more comprehensive examination to screen for stroke symptoms; just using FAST may result in a physician missing certain symptoms of a stroke.

Introduction to SAVES

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A new stroke screen using the acronym SAVES is designed to help physicians and first responders to pinpoint the signs of a stroke quickly and efficiently. SAVES stands for Smile, Arms,   Vision, Even balances and Speech — all key indicators that a person might have suffered from a stroke.

SMILE 

An asymmetrical smile may indicate the patient should be treated as a possible stroke victim. Cortical deficits often affect the lower region of the face, while patients with afflictions like Bell’s palsy or similar conditions typically present with weakness in both the lower and upper aspects of the face. If there is any doubt, however, a stroke alert should be called.

ARMS

A quick screen for sensory and motor function of patients is monitoring if there is a drift of the arms. The patient is asked to hold their arms in a supine fashion then close their eyes for 10 seconds. A slow downward drift of one side indicates that the patient should be placed under a stroke alert. Another screen involves having the patient hold their hands in front of them with their palms facing outward toward the physician. If there is a slow drifting of their fingers within 10 seconds of them closing their eyes, a stroke is likely indicated.

VISION

Patients presenting with blurred or double vision could indicate a stroke. However, using a visual field test is a more accurate indicator of the condition. The patient focuses on the physician’s nose as one or two fingers are held up in just out of the direct field of vision of the patient. Both upper and lower visual quadrants on both sides should be tested.

EVEN BALANCE

This portion of the screen is to determine if the patient has an apraxic gait. Physicians should look for a gait and stance that is wide based as they spread their legs to try to maintain their balance. Staggering and torso correction might also be noted. While dizziness or imbalance is certainly a symptom of a stroke, it is advised to be used in conjunction with another stroke symptom(s) as to not call an unnecessary stroke alert.

SPEECH

Speech is measured in two ways: aphasia (affects the expression or understanding of the written language) and dysarthria (affects the articulation of speech). The type of speech issues can also indicate where the stroke occurred. The frontal lobe of the brain is responsible for articulation so deficits in that area indicate a stroke has occurred in that region, while temporal lobe is where comprehension is centered, physicians can assume that a stroke has taken place in that area of the brain.

The easy-to-remember stroke screen, SAVES, provides physicians and first responders with valuable information in a simple and timely manner. This can lead to a quicker stroke alert and a better outcome for patients. TeleSpecialists’ average time from receiving the stroke alert call to physician arriving to tend to the patient via video cart to the patient’s bedside is 4 to 6 minutes.

For more information on how TeleSpecialists can create or enhance your TeleStroke program, visit our website at www.tele-specialists.com.

 

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TeleSpecialists in Action with HCA: When Minutes Mean Everything

Recently we received feedback on a specific case of excellent stroke teamwork with a partner hospital of ours, Portsmouth Regional Hospital (an HCA facility) in New Hampshire. This case is a perfect example of why TeleStroke is such an important part of telemedicine and how the extensive stroke protocols that we put into place with our hospital partners are vital to premium patient care.

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A man in his early 50s arrived at Portsmouth Regional Hospital from Dover Fire with stroke symptoms. The EMS team called in a Stroke Alert en route to Portsmouth Regional Hospital, which enabled the facility to have their stroke team (including the TeleSpecialist neurologist) waiting for the patient’s arrival in the Emergency Department (ED), allowing for expedited care of this patient.

The patient was diagnosed with stroke and given Alteplase (tPA) just 27 minutes after his arrival to the ED and was diagnosed with a Large Vessel Occlusion (LVO). At 56 minutes after arrival to the ED, the patient was transferred emergently to Interventional Radiology for the removal of a clot at the proximal M2 level. By the time the patient left to go up to the Intensive Care Unit (ICU), he was laughing and remained asymptomatic!

Kudos to Dover Fire and the entire team and to Portsmouth Regional Hospital: the ED physician, the ED nurses, the ED Unit Coordinator, CT and X-Ray Techs, plus the IR physicians and team. The Stroke Protocol was enacted with the TeleSpecialist neurologist and the team worked quickly and efficiently to ensure a high quality of life post-stroke for this patient.

TeleSpecialists treat every hospital that we work with as a partnership; our doctors are not just faces that beam in and beam out of the carts. They are credentialed in your hospitals and freestanding EDs. Our doctors write orders directly into your EMR to leave little to no room for error.

For more information on how TeleSpecialists can work with your facility, sign up for a demo at tele-specialists.com.

The DAWN Trial and how it could affect stroke care at your facility.

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The Background:

The DAWN (DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo), was created to measure the effects of stroke treatment in the timeframe outside the AHA and ESO guidelines of 6 hours. Funded by Stryker Neurovascular, Dr. Nogueira and Tudor Jovin, MD were named Coprincipal Investigators and led the DAWN Trial.

A 2016 analysis suggested that the benefit of thrombectomy rapidly decays over time and may no longer exist beyond 7.3 hours from stroke onset (or TLSW). (Saver et al, JAMA. 2016). The results of the DAWN are particularly beneficial for patients with wake-up strokes, strokes with an unclear onset time or witnessed late presenting strokes, which represent a large portion (around 40%) of LVO (Large Vessel Occlusion) Stroke, which previously had no proven treatment options.

The Study:

A total of 206 patients were enrolled in the study and randomly assigned a group based on factors such as site of the stroke occlusion and the time-from-last-seen-well; 107 in the thrombectomy group and 99 to the control group. Patients were randomly assigned to thrombectomy (using the Trevo device) plus standard medical care (the thrombectomy group) or to standard medical care alone (the control group). The median time of patients having received treatment in the DAWN trials was 12.2 hours and 13.2 for the control group. Patients were then followed for 90 days for results.

The Conclusion:

The study concluded that across all factors, treating stroke with endovascular thrombectomy in DAWN-eligible patients from 6 to 24 hours of symptom onset showed considerable improvement in functional independence and wellness at 90 days, versus standard care alone. Stroke can be tricky to identify but thanks to the DAWN trials, we now know that there is a larger window to treating stroke than once thought.

Tudor Jovin, MD, University of Pittsburgh School of Medicine, Pennsylvania, the study’s lead investigator, summarized: “These results greatly expand the population of patients who can benefit from mechanical thrombectomy for stroke, to significantly reduce functional impairment in the mostly severely affected patients,” he added. “Time is still obviously very important and the earlier the treatment is given the better the results, but we have shown in this trial that it shouldn’t be the only factor that determines whether we consider endovascular therapy.”

How will this impact facilities that have the capability to treat stroke patients? Patients that typically would have fallen outside of the treatment window now may benefit from thrombectomy and standard care. Any medical facility that could receive a stroke patient should review protocols to transfer patients to an EVT (Endovascular Treatment) facility as more patients can benefit from EVT. While this is certainly a pathway to a wider treatment window, “time is brain” still applies and each acute stroke case should still be treated as quickly as possible.

With the opening of this window of EVT treatment, more neurologists may be needed to assess and treat the influx of patients that now qualify in the 6-24 hour timeframe, instead of sending them straight to standard care. TeleSpecialists can implement a turnkey TeleStroke program, proving Board-certified neurologists via cart (licensed in your state and credentialed in your facility), fill any gaps in neurologist scheduling, assist your facility in stroke certification, and lower transfers of stroke patients to other facilities.

For more information on how TeleSpecialists can assist in building your TeleStroke program, contact us.

What Texas’ landmark telemedicine legislation means for the industry and the nation

Texas became the last state in the country to abolish a requirement that the relationship between patient and physician must be started with an in-person visit prior to the use of telemedicine. Governor Greg Abbott signed the landmark legislation on May 27, 2017, paving the way for patients to gain access to the services that telemedicine can offer them.

Texas Demonstrates a Great Need for Telemedicine

Texas seems like an unlikely state to be the last one to sign such a bill. As a state that sprawls over 268,000 square miles, and whose population is dispersed widely, Texas has a great deal of rural poverty with few healthcare services available. In fact, the state ranks 46th when it comes to the number of primary care doctors per capita. There are also 35 counties scattered throughout the state that don’t have a family physician to serve the population, making Texas the ideal market for telemedicine expansion.

Barriers to the Expansion of Telemedicine                                           

Even though telemedicine had already been practiced for several years prior, the Texas Medical Board began restricting its use in 2010. The board cited a prescribing rule, which mandated that physicians must establish a relationship with patients via an in-person visit prior to utilizing telemedicine’s services. Court cases ensued, with litigation dragging on for years.

Governor Abbott’s Action Ends Telemedicine Issue

With Governor Abbott’s signature on Senate Bill 1107 and House Bill 2697, the people of Texas can now access the convenience and expertise of board-certified physicians without unnecessary red tape. This welcome decision brings access to much-needed healthcare to citizens across the state.

4 Signs Your Staff Needs TeleStroke Tech Relief

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On-call services are vitally important for critical health systems like TeleStroke programs, where time is of the essence. Hospital administrators, emergency department staff and stroke coordinators must have a way to instantly connect and coordinate. Current technology makes this type of connection possible.

Here are four signs that your staff needs the latest generation of TeleStroke tech relief.

Bottlenecks in Patient Flow

If the facilities always seem to be overbooked with no relief for new intakes, you will definitely need to invest in a system that gets rid of patient flow bottlenecks. Faster on call services lead to quicker diagnoses and a more even patient count.

Slow Health IT

EHR (electronic health records) usage peaked in 2015 (62.8 percent) with a slight downturn of use last year (59 percent). That leaves a whopping 41 percent still not using the latest technology for their patients. Slower records mean slower treatments and slower receipt of on-call services. If your health IT does not match the speed of the modern generation, upgrading should be a priority.

Communication Between Departments

If patients are slow to receive on-call services, the communication between your departments may need an improvement. The older a population surrounding a hospital, the faster this communication must be in order to maintain healthy movement of patients. Patients should not be required to remember their own records; records should be easily transferrable between departments and referenced during a call.

Complaints With On Call Service

The most telling symptom that your staff may need tech relief is direct complaints from patients about on call service. Upgrading a system from front to back is the best way to avoid on call patients falling victim to preventable problems in transport and intake.

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