St. Mary’s Good Samaritan Hospital hosted more than 20 Georgia hospitals recently for a first-ever conference to enhance stroke care across the state, especially in rural communities, by showing attending hospital leaders how their facilities can become designated Remote Treatment Stroke Centers. 

Good Samaritan Hospital, the first designated Remote Treatment Stroke Center in Georgia, held the conference in conjunction with the Georgia Hospital Association, the Georgia Department of Public Health Office of EMS and other co-presenters. Meeting at Greensboro First United Methodist Church to accommodate more than 60 attendees, the conference provided a nuts-and-bolts overview of how even small hospitals can use high-tech diagnostics, telehealth systems, and other innovations to provide life-saving stroke care fast. 

Since Good Samaritan achieved designation in October 2013, two more Georgia hospitals also have been designated by the Georgia Department of Public Health: Piedmont Newnan Hospital in Newnan and University Hospital McDuffie in Thomson.

“We applaud St. Mary’s Good Samaritan Hospital for their commitment not only to providing excellent care to stroke victims in its own region, but to equipping other hospitals in the state with the tools to become Remote Treatment Stroke Centers,” said Georgia Hospital Association President and CEO Earl Rogers. “The end result of this effort is that thousands of additional stroke victims in Georgia will receive life-saving care at the right time.”    

“It’s a very exciting time for stroke care in Georgia and throughout the country,” said Michael Frankel, M.D., chief of neurology and Director of the Marcus Stroke and Neuroscience Center at Grady Memorial Hospital, speaking by video. “We’ve learned that time is absolutely critical. The longer the brain is deprived of blood flow, the greater the likelihood there will be permanent damage and, therefore, long-term disability. The quicker we can treat patients, the less likely that they will have permanent damage and the greater likelihood that they will have a good recovery.” 

In urban centers like Atlanta, Athens and Augusta, hospitals have transformed their stroke programs to provide care fast. The driving force is a clot-busting drug called tPA. When administered by IV, optimally within three hours of the onset of stroke symptoms, tPA can stop certain strokes in their tracks and even reverse damage. 

But, according to H. McCord Smith, M.D., vascular neurologist and neurohospitalist with St. Mary’s Health Care System, far fewer patients are receiving tPA than could potentially qualify for it. Studies show up to 30 percent of stroke patients could benefit from tPA, but nationwide, only 5 percent receive it. Even at stroke centers like St. Mary’s, where stroke is treated very aggressively, tPA is given in only about 13 percent of cases. 

“That’s due to three issues primarily,” Dr. Smith told the group. “First, patients arrive at the emergency department too late. We have a limited window of time in which tPA is effective – about 3 to 4.5 hours – and it takes time to stabilize the patient and complete the diagnostics needed to make sure we can give tPA safely. So if patients delay coming to the hospital, they may get to us too late for tPA to help.

“Second, many patients live too far from a primary stroke center and don’t have access to tPA at their local hospital, so their transport time puts them outside the time window. And third, there just aren’t enough neurologists to go around.”

Georgia’s Remote Treatment Stroke Center program works to address all three of these issues, Dr. Smith said.

• The program has a strong educational component to teach stroke symptoms to people in the community and urge them to call 911 immediately when symptoms appear.
• To become a Remote Treatment Stroke Center, rural hospitals like St. Mary’s Good Samaritan invest in diagnostic equipment, training for staff and doctors and enhanced communications with EMS and major stroke centers. The capability means it is often possible to start tPA much earlier than if patients had to be transported to a distant primary stroke center.
• To cope with the scarcity of neurologists, especially in rural areas, Remote Treatment Stroke Centers use telehealth systems to connect in real time with neurologists in primary stroke centers. These experts use live video, audio and data links to examine patients, consult with doctors, view CT imagery and see other test results. With their consultation and collaboration, local emergency room doctors can have confidence that it is safe to administer tPA, even if there is no neurologist in their community.

Collaboration with EMS is vital, too, several presenters noted. Paramedics and EMTs can conduct tests and relay vital information, both from the scene and while en route. Their efforts allow the receiving hospital to activate its emergency department, radiology staff, laboratory staff and stroke telehealth system before the patient arrives.

“Learning about our patients and how they enter our system, and how quickly they get a CT scan and how quickly we can institute thrombolytic therapy is very important,” Dr. Frankel said. “A 5-minute or 10-minute reduction or certainly a 20-minute reduction in the time to treatment can make the difference between a good recovery and not a good recovery.”

Speaking about the experience of St. Mary’s Good Samaritan Hospital, President Montez Carter noted that becoming the state’s first Remote Treatment Stroke Center improved quality across the entire emergency department and related areas of the hospital.

“The process brought us closer together as a team,” he said. “We invested in staff training, diagnostic equipment, the REACH telehealth system from Georgia’s Regents University, and collaborative processes across departments. That investment has already paid off. Now, we can not only administer tPA safely, we have built closer working ties with EMS and internally across departments, and that’s good for all our patients.”

Expanding that collaborative spirit was the key focus of the conference itself, said presenters Shelley Nichols, Grady’s stroke coordinator, and Joyce Reid of the Georgia Hospital Association. They stressed that the conference brought together the GHA, the Coverdell Acute Stroke Registry, the Department of Public Health Office of EMS, American Heart/Stroke Association and the Georgia Stroke Professional Alliance, as well as representatives from Grady Memorial Hospital, Piedmont Newnan Hospital, St. Mary’s Health Care System and St. Mary’s Good Samaritan Hospital. 

“All of these entities help to make the Remote Treatment Stroke Center possible across Georgia, not just the entities themselves but all the people who are committed to blanketing the state with excellent stroke care,” Nichols said. “The Remote Treatment Stroke Center designation is very possible because there are so many willing helpers.”