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Naples Comprehensive Health TeleStroke Case Study

By: | Tags: , , , , , , , , , , | September 24th, 2024

NCH sought to elevate its already strong stroke program after identifying shortfalls in thrombolytic cases across the system and at NCH Baker.
NCH partnered with TeleSpecialists to implement key strategies to improve DTN times in their facilities.
Fine-tuning processes led to record setting thrombolytic improvements at NCH and NCH Baker, paving the way for industry-wide stroke care advancements.

ABOUT NAPLES COMPREHENSIVE HEALTH

Naples Comprehensive Health (NCH) is a prominently recognized Advanced Community Healthcare System™ serving Southwest Florida with premier routine, critical, and specialty care. NCH is a locally governed non-profit and is recognized as one of Healthgrades America’s Top 100 Hospitals which puts it in the top 2% in the nation for clinical excellence, in addition to being named a Top 50 Hospital for Surgical Care. The system is more than just two hospitals (referred to as the NCH Baker Hospital and NCH North Hospital) with a total of 713 beds – NCH is an alliance of over 750 physicians and medical facilities in dozens of locations throughout Southwest Florida and is the region’s only Joint Commission accredited Comprehensive Stroke Center.

THE CHALLENGE

From 2021-2023, 82% of system-wide thrombolytic cases were completed in under 60 minutes (goal: 85%), 59% in under 45 minutes (goal: 75%), and 23% with door-to-needle (DTN) times under 30 minutes (goal: 50%). At NCH Baker Hospital, 88% of cases met the 60-minute mark, 65% the 45-minute mark, and 27% the 30-minute mark. A performance improvement review identified delays in activating stroke alerts for triage/walk-in patients, with only 35% of alerts activated within 10 minutes of arrival. Currently, ED physicians evaluate and activate stroke alerts as needed.

THE SOLUTION

Key strategies were implemented, including the launch of a nurse activation model, extensive training and education regarding the stroke screening tool, mock stroke alerts, and daily data reviews with specific follow-up on outliers.

THE OUTCOME

System Improvement: As of June 2024, 92% of thrombolytic cases were completed in under 60 minutes, 76% in under 45 minutes, and 49% had DTN times under 30 minutes. There was a 15% increase in stroke alert activations within 10 minutes for triage patients.

NCH Baker Hospital Improvements: By June 2024, 97% of thrombolytic cases were completed in under 60 minutes, 89% in under 45 minutes, and 63% had DTN times under 30 minutes, marking a 36% improvement in DTN times under 30 minutes and a 29% improvement in times under 45 minutes. After implementing the nurse activation model, activations within 10 minutes for triage patients increased by 16%. In March 2024, a system record was set with a thrombolytic administration within 13 minutes of arrival. Additionally, door-to-reperfusion times for thrombectomy patients improved by 10%, averaging 129 minutes, with a record 16-minute door-to-groin time in 2024.

DOWNLOAD THE CASE STUDY

Nattasha Acevedo, MD

Dr. Acevedo received her medical degree from the Ponce School of Medicine in Puerto Rico and did her neurology residency at Montefiore Medical Center in New York. She went on to do a clinical neurophysiology fellowship at Emory School of Medicine in Atla nta, Georgia and then joined private practice in Fort Myers, Florida. She currently resides in San Juan, Puerto Rico. She likes running, paddle boarding and spending time with family.
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Bernadette Borte, MD

Dr. Borte received her medical degree from St. Matthew’s University School of Medicine in Grand Cayman. She completed her neurology residency at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. Her areas of interest include inpatient neurology and acute stroke. When not working, she enjoys spending time outdoors with her family. Dr. Borte joined the TeleSpecialist family in March of 2019.
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Mazen Almidani, MD

Dr. Almidani is board certified in pediatrics by the American Board of Pediatrics and board certified in epilepsy, as well as neurology with special  qualification in child neurology by the American Board of Psychiatry and Neurology.  Dr. Almidani is happily married with 4 children. His oldest son has autism and his daughter has complicated seizures; both were a drive for him to become a neurologist. Dr. Almidani enjoys soccer, running and spending time with his family. He is very involved with his sons’ therapy and helping with daily challenges. He is double board certified in Pediatric and Adult Neurology and Epilepsy. He sees children and adults. He also participates in charities for children in Syria who may be underprivileged and/or affected by the war. Dr. Almidani joined TeleSpecialists in August 2020.
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Amanda Cheshire, MD

Dr. Cheshire received her medical degree from the University of Louisville School of Medicine in Louisville, Kentucky. She completed her neurology residency at the University of Cincinnati Medical Center in Cincinnati, Ohio. She did a fellowship in neurophysiology at the University of Michigan Medical School in Ann Arbor, Michigan. Dr. Cheshire is double board certified in neurology and clinical neurophysiology. She enjoys traveling, reading and music. She currently resides in Viera, Florida.  Dr. Cheshire joined TeleSpecialists in June 2019.
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Jessica Floyd, MD

Dr. Floyd completed her neurology residency at Mayo Clinic in Jacksonville, Florida followed by fellowship training in clinical neurophysiology with focus in EEG and epilepsy at the Medical University of South Carolina in Charleston, South Carolina. She has particular interest in hospital neurology and patient education as well as the blossoming specialty of lifestyle medicine. She strives to take advantage of every encounter with patients and medical staff to empower them to do their own research into how daily thoughts, choices, and habits can add up to create greater and longer-lasting brain and neurologic health for ourselves and our loved ones. She lives in Florence, South Carolina with her awesome husband of 13 plus years and three beautiful children. She is an avid yogi, astrologer, and lover of food and all things neurology! Dr. Floyd joined the TeleSpecialist family in July 2017.
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Nancy Futrell, MD

Dr. Futrell received her medical degree from the University of Utah in Salt Lake City, Utah. She also did her neurology residency at the University of Utah as well as a research fellowship in cerebral vascular disease at Jackson Memorial Hospital in Miami, Florida. She currently resides in Salt Lake City, Utah. She has authored 2 books and 50 peer reviewed papers. 
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Rebecca Jimenez-Sanders, MD

Dr. Jimenez Sanders received her undergraduate degree from Emory University, and her medical degree from the San Juan Bautista School of Medicine in Puerto Rico. She completed her neurology residency at the University of South Florida in Tampa, Florida, where she also did a specialized headache medicine and facial pain fellowship. She currently resides in Tampa, Florida with her husband and her two daughters. She is also fluent in Spanish and Italian languages, and enjoys photography, baking, boating, and biking.
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Cory Lamar, MD

Dr. Lamar received his medical degree from Meharry Medical College in Nashville, Tennessee. He completed his internship and residency at Wake Forest Baptist Health in Winston Salem, North Carolina. Following residency, he completed a clinical fellowship in neurophysiology, with a concentration in epilepsy. He currently resides in Florida and enjoys outdoor activities.
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Clifford Meyers, MD

Dr. Meyers received his medical degree from Brown University in Providence, Rhode Island and his MBA from the Simon School of Business at the University of Rochester in Rochester, New York. He completed his neurology residency at the University of Rochester, where he also did a neurophysiology fellowship. Dr. Meyers resides in Webster, New York with his wife and daughter. When not doing teleneurology, he enjoys playing sports with his wife and daughter.
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Tao Tong, MD

Dr. Tong received her medical degree from the University of Miami School of Medicine in Miami, Florida. She completed her neurology residency at Jackson Memorial Hospital in Miami, Florida, where she also did a neuromuscular/EMG fellowship.  She currently resides in College Station, Texas. Dr. Tong is married with two boys. She enjoys spending time with her family, traveling and reading.
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Shubhangi Chumble, MD

Dr. Chumble attended BJ Medical School. She is a board certified neurologist with a subspeciality interest in sleep medicine. Dr. Chumble did her residency at Howard University in Washington DC and has practiced neurology since 2001 in private and corporate settings. She lives in Melbourne, Florida and loves the sunshine state. Her hobbies include yoga, meditation, cooking , traveling and meeting new people. She also loves to do stained glass, pottery and painting. She joined TeleSpecialists in June 2019.
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