Lean Six Sigma and TeleMedicine

According to Investopedia, “Lean Six Sigma is a team-focused managerial approach that seeks to improve performance by eliminating waste and defects. It combines Six Sigma methods and tools and the lean manufacturing/lean enterprise philosophy, striving to eliminate waste of physical resources, time, effort and talent, while assuring quality in production and organizational processes.”

To the average Joe, applying this in the medical community seems like common sense: I need emergent medical help and would really like the quickest and most effective care without wasting time or effort.

Obviously, we know the entire world doesn’t quite work like this. However, TeleSpecialists does. We were literally founded based on the principals of lean management: What is the quickest and most effective way to see a patient that as possibly suffered a stroke? TeleSpecialists’ founder and CEO, Dr. Nima Mowzoon, recognized telemedicine as the future for faster stroke care and wanted to be a part of it. In 2013, he founded what would grow to become TeleSpecialists.

Very simply, telemedicine and implementation of lean management are both methods to eliminate the waste of time, which, in stroke emergencies, is critical to a more effective recovery. By having our neurologists available 24/7/365 to appear in front of the patient on-screen within minutes of the stroke call, TeleSpecialists’ neurologists can assess and treat strokes without having to call the on-site neurologists in from home in the middle of the night or interrupt them from other patients and duties. We’ve even heard on-site neurologists say, “I can’t even walk across my hospital in 4 to 6 minutes.”

With the findings of the DAWN trial, yes, the window timeframe has opened, but this means more patients are eligible for alteplase treatment, thus needing more neurologists to assess and treat stroke patients.

As TeleSpecialists grew and added more hospitals, we were able to do so quickly and sustainably through the popular Lean acronym PDCA (Plan, Do, Check, Act). The team at TeleSpecialists has a fairly regimented blueprint of how we work with different hospitals around the country. We say “fairly”, because we know that every hospital is different, staffing is different, and processes are different. But at TeleSpecialists, we “Plan” to implement the most efficient hospital scenario, “Do” the work to get the hospital live with our services, then frequent follow up by our Quality team to “Check” in on what works and what doesn’t work and lastly, quickly “Act” on any adjustments or changes that need to be made, then start the cycle over again to “Plan” improvements on the process.

We have also implemented this tactic in many aspects of our company: credentialing, marketing, sales and even the doctor’s stroke process. For more information TeleSpecialists and TeleNeuroHospitalist or TeleStroke services, call us at 866-785-7769.


Stress, Stroke and the Holidays

It’s the most wonderful time of the year?

It’s the most wonderful time of the year! It can also be one of the most stressful – not just on your wallet, but on your body as well. In fact, according to a University of California-San Diego study, cardiac deaths rise nearly 5% on December 25, 26th and January 1st. Deaths from other causes also rise at that time of the year, but not nearly as much. While there are a lot of factors that can go into a cardiac death, stress is certainly an instigator that can lead to a stroke, possibly leading to cardiac death.

Wait… Back Up… How does this happen?

Biologically, the brain triggers chemicals during stressful events to help us deal. No matter what kind of stress, there are two primary chemicals: 1) Cortisol and 2) Adrenaline. Cortisol is a hormone that forces our body to retain water and sodium to help keep blood pressure up, preparing us to have the strength to run or fight. Similarly, adrenaline causes our heart rate and blood pressure to rise to pump blood to vital organs.

There are two kinds of stroke: Hemorrhagic (brain bleed)and Ischemic (blocked arteries). Both are serious medical concerns, so understanding the potential causes is one step towards prevention.

By living in a chronic or high state of stress (hello holidays!) or by not getting enough sleep, you have constant raised levels of cortisol, retaining salt and increasing blood pressure. Blood vessels can burst if they’re weakened, the blood leaks into the surrounding tissue and not to the brain – and you have a hemorrhagic stroke.

Conversely, eating poorly (hello again holidays!) can lead to cholesterol buildup, blocking blood flow in the arteries which can trigger an ischemic stroke.

We’re not trying to be the doom and gloom guy here… With Christmas fast approaching, we wanted to take a moment to remind you that while stress during the holidays is inevitable, there are a lot of things you can do to lower your stroke risks.

  1. Enjoy food and alcohol – in moderation! Between food and alcohol, overindulgence is rampant. Alcohol can irritate the heart muscle and cause atrial fibrillation, increasing stroke risk. Cholesterol can block blood vessels, causing an ischemic stroke.
  2. Five-minute meditation. It helps, seriously. And five minutes a day for yourself can help you feel less stressed about the day, let things go and redirect yourself to make you feel better.  You can even do this during a walk. Exercise plus meditation! 
  3. Be vigilant with medication. According to a Mayo Clinic news release on avoiding heart attacks and strokes during the holidays, “varying schedules, additional activities and travel can lead to lapses in the way you take medication during the holidays.” So, remember your medications – especially if you are on blood thinners or blood pressure pills.
  4. Know the symptoms of a heart attack or stroke – especially if you are at a higher risk.

Heart attack: Chest pain, upper body pain, shortness of breath, lightheadedness, sweating, nausea and heart palpitations

Stroke: Trouble with speech, paralysis of face, arm, or leg – especially if it’s just on one side, headache, trouble with vision or balance. See our SAVES blog!

Remember, a stroke can happen for a number of reasons; you can’t blame stress from your crazy Uncle Al for your Christmas-time stroke. If you think that you or someone you love is having a stroke, get to the emergency room as quickly as possible! Strokes can often be fully treatable and recoverable if medication is properly administered.

For more information on how our doctors can be at your stroke patient’s bedside via telemedicine cart in an average of 4 to 6 minutes, contact us at 1-866-785-7769.

Happy Holidays from TeleSpecialists!

Stroke Imaging with Dr. Mazen Abuawad

During this webinar, Dr. Abuawad will explore different types of imaging and interpretation, plus evaluating and triaging patients based on imaging results.

 Having practiced for over 20 years, Dr. Mazen Abuawad is certified in Diagnostic Radiology and Vascular & Interventional Radiology by the American Board of Radiology. 

Dr. Abuawad currently works for NCH in Naples, Florida and is licensed in Nebraska, Illinois, Missouri and Florida.

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.


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.


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.


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.


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 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.


Photo by Pixabay on Pexels.com

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


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.