Quality Support

Quality Support

TeleSpecialists’ quality-driven program has compiled historic data showing average Door-to-Needle times consistently at or below national recommended targets and utilization rates often at 20%. Quality metrics are reported on every consultation.

Our partnership to improve quality starts on day one – every facility is assigned a personal Quality Program Specialist (QPS) to support Process Improvement (PI) initiatives that work with your hospital to obtain top-performing results.

Additional resources include a Vice President and Director with over 35 years of quality experience together.

Quality Support Services Beyond the Emergency Room

  • Initial and ongoing analysis of care processes for acute stroke management
  • Weekly, biweekly or monthly PI team meetings
  • Accreditation/certification support
  • On-site training and consultation
  • Best Practice Compendium (based on lessons learned from our many partnerships with diverse hospitals nationwide)
  • Community activity support
  • Stroke Coordinator onboarding
  • Partner for presentations, publication and research

Real-time Acute stroke Process Improvement Driven initiative (RAPIDi)

Introducing a new scientific approach for Quality Management. Empowered by robust data governance tools, and based on the DMAIC scientific method for Process Improvement, RAPIDi uses data-driven quality management strategies for a standardized approach to process and performance improvement. Implementation of the Quality Management System (QMS) specific for stroke care involves onsite education and implementation of Standard Work processes, followed by ongoing PI. TeleSpecialists provides software tools as well as comprehensive neuroscience leadership support staff for complete Quality Management oversight and collaboration. The stages of the system are represented as DEFINE, MEASURE, ANALYZE, IMPROVE, CONTROL.



  • The Continuous Process Improvement (CPI) team is selected, from all team members that are involved in the patient value stream
  • Standard Work process is created for different workflows pertaining to respective value streams
  • Data needs, collaborative data collection tools, quarterly goals, and metrics of performance for the team are clearly defined
  • Post Go-Live processes for CPI are defined


  • TeleSpecialist’s proprietary quality management software, TeleCare, provides tools to measure metrics of performance in real time
  • TeleCare is used as a robust data collection tool by all team member
  • Neurologists on the case and staff on the ground all have benefit of using both the smart phone application or the web-based desktop program, as adjunct to the data captured by the native EMR, for a collaborative data capture


  • This stage primarily involves different pathways that trigger a single case review, formal root cause analysis, and methodologies for trend analysis and opportunities for PI
  • Triggers for review include:
    • Direct feedback from physicians and or clinicians on ground
    • Metric/milestone outlier
    • Identification of opportunities in serial root cause analysis
    • Identification of opportunities in process outlier trends
  • Delays in milestone key process steps of the value stream activate a formal root cause analysis


  • This stage defines and executes Post Go-Live processes for Continuous Process Improvement (CPI). The process is defined by PDCA.
    • Plan
      • System waste (non-value added activities) are identified and countermeasures are proposed
    • Do
      • Implementation of countermeasures to address who will do what, when and how
    • Check
      • Was the action plan implemented
      • Desired results obtained
      • Is there need to modify the plan
    • Act
      • Once the new process is deemed feasible and desired results are obtained, it is implemented in a new modified Standard Work


  • Focus is to monitor the new process to assure that it is feasible, well implemented, and maintained
  • Activities to monitor the new standard work and PI plans are being followed

Learn More With TeleSpecialists

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.

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.

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.

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.

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.

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. 

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.

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.

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.

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.

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.