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Quality Improvement in Acute Stroke Care: A TeleNeurologist’s Perspective

By: | Tags: , , , , , , | September 15th, 2023

We all know that time is brain when it comes to stroke care. Every second that passes during an acute stroke is critical in determining a patient’s short – and long-term health, and efficiency and skill in acute ischemic stroke (AIS) treatment have direct and measurable patient benefits. Developing efficiency in AIS care means identifying delays in treatment and following best practices to create opportunities for improvement. Efficiency in AIS treatment also relies on expert teamwork, from the on-screen neurologist to the on-site stroke staff.

Telemedicine has become the standard of treatment in AIS care, permits faster physician response times, and maximizes physician resources during stroke treatment and thrombolytic administration. The increasing prevalence of telemedicine in healthcare positions neurologists at the crux of AIS treatment, and the on-screen neurologist’s expertise is essential in ensuring that acute stroke care is executed seamlessly.

Learn More About Our TeleStroke Services

How do you improve stroke care outcomes for your patients and facilities? 

Enter quality improvement. Quality improvement is a process that ensures better patient care and improves metrics for facilities by decreasing key treatment times to match industry standards. This, along with best practices, will demonstrably enhance patient outcomes.

What is Quality Improvement?

Quality improvement is a framework used to improve patient care and standardize processes. It reduces variation, achieves predictable results, and improves outcomes for patients, healthcare systems, and organizations.

What will implementing Quality Improvement for acute stroke treatment mean for facilities?

The most important goal of quality improvement in treating AIS is reducing door-to-needle (DTN) times (for thrombolysis) and door-to-groin (DTG) puncture times (for thrombectomy). The American Heart Association recommends DTN times less than 60 minutes and DTG puncture times less than 90 minutes. Since some patients who undergo thrombectomy will first receive a thrombolytic, delays in DTN times can also result in delays in DTG times. Ultimately, reducing DTN times can improve outcomes for all acute stroke treatments.

Quality improvement focuses first on improving facilities’ DTN and DTG times. Improving these two simple stroke care metrics has widespread effects on improving stroke care in general, from increased efficiencies in the emergency department to improved downstream nursing, rehabilitation, and stroke prevention outcomes. The American Heart Association provides best practice recommendations that complement quality improvement processes for reducing DTN and DTG times.

Best Practices for the On-Screen Neurologist

Ensuring the best outcomes for AIS treatment requires a combination of quality improvement processes and teamwork from all care team members. During a stroke alert, the on-screen neurologist should lead the care team by facilitating treatment given quickly and safely, guided by clinical expertise, and with attention to critical metrics (DTN and DTG times). The patient’s and family’s experience during acute stroke treatment is also a priority, and the on-screen neurologist must, as much as possible, cultivate an environment that is calm and free of distractions. Interactions between care team members are respectful, and consensus medical advice is represented consistently by physicians and nurses alike.

Our TeleNeurologists Ensure Quality Improvement for Our Partners

As telemedicine has taken a larger and more pivotal role in AIS treatment, the importance of quality improvement has become abundantly clear. By implementing quality improvement processes in our TeleNeurology services, our neurologists streamline patient care and raise the bar for facility metrics, aiming to meet industry standards for treatment times, highlighted by an average physician response time of three minutes. Saving lives is the cornerstone upon which we built a foundation of standardized processes, reduced variations, and improved outcomes that we guarantee our partner hospitals through our transformative telemedicine services. It’s through the combination of quality improvement and dedicated teamwork, led by our TeleNeurologists, that we strive to create an environment where every precious second counts for the betterment of our patients’ lives.

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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