Before Baylor Health Care System (BHCS) began its hub-and-spoke model of stroke care with telemedicine in 2013, Baylor Medical Center of Irving only treated one stroke victim with tissue plaminogen activator (rtPA).
In the program's first 26 months, 56 of 58 eligible patients received the clot-busting drug that minimizes the damage caused by a stroke if it is administered within 3-4.5 hours after symptoms begin.
Baylor University Medical Center at Dallas is the system's hub and Baylor Irving is one of the seven community hospital spokes, with more planning to come aboard in the near future. The system, often called telestroke, allows neuro-hospitalists on the medical staff at Baylor Dallas to evaluate patients remotely and make recommendations to emergency medicine doctors at community hospitals. The doctors use iPads and laptop computers to communicate. The physicians located at Baylor Dallas use a portable robot to view and evaluate stroke patients at the community hospitals.
Typically, if an emergency medicine doctor suspects a patient has had a stroke, the Baylor Dallas telestroke team is notified. The team, which is always available, includes a program manager, clinical coordinator, vascular neurologists, neurosurgeons and radiologists. The team recommends the most appropriate care after the evaluation.
The telemedicine program has allowed Baylor Irving to be certified as a primary stroke center (PSC) by The Joint Commission, which it says it gives to facilities "that make exceptional efforts to foster better outcomes for stroke care." Four participating hospitals—Baylor Medical Center at Garland, Baylor Regional Medical Center at Plano, Baylor Regional Medical Center at Grapevine and Baylor All Saints Medical Center at Fort Worth—also have PSC certification. Other spoke hospitals include The Heart Hospital Baylor Denton and Baylor Medical Centers in Waxahachie and Carrollton.
Penny Huddleston, PhD, RN, stroke coordinator for Baylor Irving, said, "We could not offer the stroke care which we are offering to patients at Irving (without telemedicine). We have had a remarkable improvement in patient outcomes."
Huddleston wrote an article about the hub and spoke model for the journal Critical Care Nursing Clinics of North America, noting that the modelhas increased Baylor Irving's access to neurology expertise and decreased the number of transfers to Baylor Dallas to keep patients closer to home.
Nationally, about 15-40 percent of patients with symptoms of an acute stroke arrive at hospitals in time to receive rtPA; however, the treatment rate is low. Only about 6.7 percent of ischemic stroke patients receive the therapy at certified U.S. primary stroke centers, and about 2 percent are treated at non-certified U.S. hospitals. The treatment rate for hospitals participating in the BHCS hub and spoke system is more than 12 percent, according to Lindsay Snodgrass, RN, stroke coordinator at Baylor Dallas.
Snodgrass said the telestroke program has experienced exponential growth. Baylor Dallas quadrupled the number of stroke consultations in 2014, compared with the previous year. She said the hub provides 60-70 consultations a month for spoke hospitals.
Dion Graybeal, MD, medical director for Baylor Health Care System’s hub-and- spoke stroke program and the architect for the hub and spoke system, estimates Baylor Dallas stroke teams will consult on about 800 cases in community hospitals this year.
"We've seen an increase in consultations from all of our regional medical centers. Also, we don't just log on and log off only where there are cases to be evaluated. We're constantly monitoring quality processes and working toward performance improvement," he said.
Dr. Graybeal and Snodgrass both said the stroke team needs to grow to accommodate all of the community hospitals that want to become spokes in the system.
Baylor Dallas also is working toward achieving the highest stroke certification, called a comprehensive stroke center, by the end of the year. The Joint Commission certification recognizes hospitals that meet standards to treat the most complex stroke cases.
"The (hub and spoke) program has helped us as a system to provide better, safer, more timely and effective patient-centered care. Community hospitals participating in the program have timely access to neurology experts," Snodgrass said.
About Baylor Scott & White Health
Baylor Scott & White Health, the organization formed from the 2013 merger between Baylor Health Care System and Scott & White Healthcare, is today the largest not-for-profit health care system in the state of Texas. With total assets of $9 billion* and serving a population larger than the state of Virginia, Baylor Scott & White Health has the vision and resources to provide its patients continued quality care while creating a model system for a dramatically changing health care environment. The organization now includes 49 hospitals, more than 800 access points, more than 5,800 active physicians, 35,000 employees and the Scott & White Health Plan.
