Welcome to our comprehensive guide on how Stroke Hub and Spokes Help in Keeping the Wheels Turning. As experts in the field of stroke prevention and recovery, we believe it is crucial to provide our audience with in-depth information on how to stay proactive in their journey towards a healthier lifestyle. In this guide, we will dive into the benefits of Stroke Hub and Spokes and how they can aid in improving your overall health and well-being. Join us as we explore the importance of taking care of your body and mind through the use of these valuable resources.

– [Gino] Happy Wednesday everyone, And welcome to today's webinar, "Stroke Hub and Spokes:
Keeping the Wheels Turning." Before we get started, I'd like to go over a few items So you know how to
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customer service team Whose contact information can be found In your webinar confirmation email. To view live closed captioning
during today's presentation, Please utilize the hyperlink in the chat. I'd now like to pass it to
my colleague, Jeanie Luciano, Our National Senior Program Manager, For Get With The
Guidelines Stroke and Afib. Jeanie? – [Jeanie] Thanks, Gino. Next slide, please. We wanna welcome everybody today.

Next slide. So just as a heads up,
we're celebrating 20 years Of Get With The Guidelines
Stroke this year. So you will see things
coming out over the course Of the next year going into early 2024. Next slide. So I couldn't let this pass. As we kick off American Stroke Month And head into Nurses week, I wanna acknowledge our
colleague Lynn Hundley, Who we unfortunately lost in
November due to glioblastoma. If passion was a person, it would be Lynn. I would normally ask
for a moment of silence, But there was nothing
silent about our friend Lynn And to honor her and her work,
really do it with actions, Mentor someone, thank your mentor, Continue to learn and
care for your patients And she would really love that. So just an acknowledgement
of our colleague. Next. We have quite a treat for
you of presenters here today. We got the true top of the line. I'm gonna give you a brief
introduction to each of them. So Michele Sellers. Michele Sellers has been The Director of the NeuroRescue
Program at Penn Medicine Since April of 2013. In that capacity, She coordinates the
Penn Telestroke program, Ensures efficient transfers
of neuroscience patients To the Penn Medicine system, And supports stroke program development, Across a network of six
Penn Medicine hospitals, As well as multiple alliances
outside of the system.

She has been a neuroscience
nurse for over 34 years. Her previous experience includes Acting as a clin specialist For the Department of Neurosurgery, As well as the coordinator
for stroke clinical trials. She has been a stroke certified
registered nurse since 2015 And has presented
regionally and nationally On numerous stroke topics. Our next presenter is Kimberly Holmes. Kimberly has been a registered
nurse for 20 plus years And is currently the stroke
program clinical nurse Specialist for Bayhealth in Delaware, For both the Kent and Milford campuses. Kimberly has presented numerous times At the state and national
level on acute stroke care And cultural sensitivity. Kim is particularly passionate
about health disparities That affect women and minorities. She has been an avid volunteer for the AHA And has been elected to the
position of Board President Of the Delaware Heart
and Stroke Association For the term of 2020 to 2023. She is also an active member Of the Stroke Systems of Care
and Stroke Nurse Focus Group. Kimberly is the inaugural chair Of the Delaware Stroke Systems Committee, Which was formed under the Office Of the Division of Public Health. She is very proud of the collaboration Across Delaware Health Systems
and the positive outcomes That have been achieved in
the Delaware Stroke System. We also hope to get Ken Reichenbach, That crazy guy's taking
care of patients right now, But hopefully Ken will be able to join us.

He has spent 26 years in the
Lehigh Valley Health Network Working in a variety of positions From radiographer, nurse
and nurse practitioner. For the past 14 years, He has worked in the Stroke Program And serving as the Program Director For the Mobile Stroke Program. Kenneth helped to develop
the tele neurology program, The Mobile Stroke Program, And the Neurointerventional
Radiology Clinic. He has worked on the implementation Of artificial intelligence For neurological imaging at Lehigh Valley. He has also worked as an
advocate between Lehigh Valley And EMS agencies providing education And outreach to the community. Additionally, from Lehigh
Valley, we have Erin Conahan. Erin has been the
Clinical Nurse Specialist For the stroke program at Lehigh Valley Since August of 2019. She serves as a role model,
educator, and resource person To facilitate professional
development of staff, Improve community awareness, And incorporate evidence-based
guidelines into practice. This is done through her oversight Of performance improvement, Community outreach and
continuing stroke education. Additionally, she oversees
institutional compliance With joint commission Disease Specific Certification standards For the stroke center certification And coordinate certification process. She has presented regionally And nationally on various stroke topics.

And then last but not
least, from Lehigh Valley, We have Claranne Mathiesen. Claranne has been a member Of the Lehigh Valley Hospital
stroke team since 1999. She is recognized for over
37 years in nursing expertise In neuroscience nursing. Her experience includes emergency
care, interventional care, Neurocritical care and
medical surgical nursing. She provides consultative
services in the area Of stroke center development And ongoing maintenance
of acute care services To support delivery of care. Claranne works with a large
tertiary stroke system That supports nine acute stroke campuses. Her experience includes
overseeing clinical operations, Development of ongoing
performance improvement And quality efforts and staff development. Claranne is actively involved
in stroke care delivery, Both locally and nationally, Volunteering for several
American Stroke Association And American Association Of Neuroscience Nurses
Committee and Task Force. So I am at, we'll go to the next slide That will show our objectives for today. So our objectives for today are to develop An understanding of
essential components of Successful acute stroke
management during transitions From Spoke hospital to Hub hospital, And identify opportunities For collaborative quality
improvement in the Hub And Spoke hospitals. So I am happy to hand it
off to our first speaker, Michele Sellers. – [Michele] Thanks so much Jeanie,

And hello to everyone
who has joined the call. I'm here to speak to the
Hub and Spoke experience From an urban academic center perspective. So as Jeanie said, I am working
at Penn Medicine currently And our Hub at Penn Medicine Is the hospital of the
University of Pennsylvania, Which is our CSC. In addition, we have five other Penn owned Stroke network hospitals, Four of which are primary stroke centers, One of which is soon to be a
thrombectomy capable center. Two of those primary stroke centers, Penn Presbyterian and
Pennsylvania Hospital, Are located very close
to us in Philadelphia. One Chester County Hospital is
in the Philadelphia suburbs. And then we have another
center at Princeton, Which is in New Jersey. The soon to be Thrombectomy Capable Center Is about 80 miles away in
Lancaster, PA, Lancaster General. We also partner with three
other hospital systems That are not Penn-owned, They are all primary stroke centers. Currently all of the partner hospitals Are within transfer distance. So, any patients that we evaluate At our Spoke hospitals that
need an advanced level of care Are coming down to the Hub at Hub, Which is a little bit of a mouthful, But hopefully I won't make
that mistake too many times During this talk. Gino, I'll go on to the next slide. I have no disclosures. So having been at this for a little while, I feel like I've seen a
real switch in sort of

The mindset of how Hub
and Spoke models work. I think in the beginning There was very much a
Hub centric viewpoint Where the Hub dictated
processes or you know, Was the one that would say how policies And procedures would work. I feel like we've really moved
in the opposite direction now And that's for the good. We really seem to be more
Spoke centric right now. We work very, very
collaboratively with our Spokes To improve our entire sort of
stroke ecosystem as it were. Over the years, as we've worked To develop this stroke system, We've learned of really a few
really good keys to success. First off, humility,
listening is absolutely vital. We cannot go into a Spoke partnership Believing that we have all the answers. We really need to listen to the
teams at our Spoke hospitals For, after all, they're this experts. They know their hospitals, They know their patient
population, their environments, They know their strengths
and opportunities Better than anybody. So it's only by first
listening are we able To then determine how
best we can integrate The things that an academic medical center Brings to the table into the
improvement of stroke care. Then we move on to teamwork. Once we've listened and learned, Then we can team up with the
folks at our Spoke hospitals And really start to navigate
the incredible complexity Of providing exceptional
stroke care across our network. Now we have a lot of tools to do that And we utilize them all,

But we found that not all
tools are needed at all Spokes. So again, we really need to
personalize the solutions That we offer to each
of our Spoke hospitals. Telestroke is one of our older tools, But certainly one of our most vital ones And we still lean on that. Added to that though, We now are able to offer
options for tele-neurology, As well as tele neurocritical care. And these have been important tools As they've helped some
of our Spoke hospitals Maintain some patients at the local site Rather than transferring
patients for monitoring. And this has been just a win-win. The Spokes really would like to keep As many patients as they can. The families and patients
don't wanna transfer If they don't need to. They'd prefer to be in their community And obviously I think all
tertiary medical centers Are dealing with bed
strain in this environment. So, this really has helped
us across the network. Another tool is our shared
image interpretation software. Of course this allows us
to quickly access imaging Across all of our network hospitals, Allowing for rapid diagnosis
and treatment decisions. One of the more exciting tools That we're still really
harnessing the power of Is our shared EMR. Across our Penn owned facilities, We are all on EPIC and all
on the same version of EPIC. So we're just beginning to
develop the building blocks To help sort of streamline
stroke processes Across that part of our network.

We're currently using a
consistent shared EPIC-based Alerting system for all ED stroke alerts. So regardless of what
ED our patients go into, On our Penn-owned facilities,
we're able to alert, Use the same haiku alerting platform. What that allows us is
improved data collection At each of our sites Because it goes through
EPICs that we're able To pull a report on all of our alerts, But it's also one of the building blocks To streamlining alerting
directly to the team At the comprehensive stroke center. This week we also launched an EPIC-based Secure chat function, Which allows currently
for faster communication Among the teams as we move patients Either from our ER or
from another hospital Into our thrombectomy suite. My vision is a network
where a Spoke hospital Will be able to place
the stroke alert order When that patient hits the ED, That will launch an alert
to the phones of the team At the CSC. From that alert on their phone, They'll be able to access the
patient record, review images, And begin a secure chat
with the treating team Over at the ED. In that chat, they could determine If a telestroke is needed. If so, we could just go
ahead and beam into the cart And begin that telestroke consultation. In my dream world, That would also alert,
if we decide to transfer, It would also alert our transfer center

And our Penn Star team
who does the transfer. Now we're nowhere near
that yet but we, as I said, Are laying the foundation
and are really hopeful That this is going to help us streamline And hasten the care of our patients. I'll also add that the
EPIC based alerting haiku That we're currently
using was actually piloted At one of our primary
stroke centers at Princeton. So again, just another example That not all the knowledge and innovation Flows direct from the Hub exclusively. We're really working in
a collaborative manner To improve care. Lastly, but most
importantly, communication. I've already alluded to the
importance of communication For individual patient
care in the secure chat And moving patients into
the IR suite, for example. But it's also vital for the the Hub To then communicate back
how that patient does If they end up being transferred And sort of close that loop. While the patient-centered
communication's obviously vital, I think we also need to think about Sort of the bigger picture and
the communication of our data Across the network. In my role, I pretty
much record and track, Well almost everything we do, Calls, times of calls to
how long we're on calls, Do we recommend treatment,
do we recommend transfer? So I'm constantly collecting
data that is helpful In quality improvement work. Across our network, obviously, All of our stroke centers
are collecting data To meet their metrics,

Whether that's door and door out At our primary stroke centers, Door to (indistinct) At our comprehensive and
thrombectomy centers, And we all play a part in
improving each other's metrics. So I think it's really important That we share that
communication are transparent And really work together To elevate all of our practice. So one size doesn't fit all,
solutions must be curated, And in keeping in mind
the strengths and benefits Of all of our Spokes. I wanted to just speak, Talk through one of the curated solutions That we came up with that was specific For our downtown Spokes. It may be counterintuitive
but our two closest Spokes Were the Spokes that we
have the most trouble Getting transferred to us, That's due to traffic but
also candidly it's due To lack of ground resources For moving patients from Our center city primary
sites to our Hub hospital. So we put our heads together and came up With an expedited
thrombectomy transfer process, Which you see pictured here. What the purpose of
this was to really work In parallel rather than in series. So, the plan is when a patient hits One of our PSCs downtown, If they come in with gaze preference Or aphasia, hemiparesis, And they're within a 24 hour window, We're really asking them
to call us on triage,

Let us know so we can start identifying And moving assets. Even if we end up canceling that transfer Because the CT scan shows
a bleed for example, We're at least on our way and
so when we make that decision, Our resources are there at the bedside. And just as, we can go to the next slide, As a quick little case study Showing how this process can work, This is a patient that
presented to our emergency room At Penn Presbyterian. They came in around 6:40 in the morning With left-sided hemiparesis
and facial droop, Which caused them to initiate the call For an expedited transfer. They called us from the
triage so within five minutes They were letting us know
that they had a patient, They anticipated transfer. We began to identify resources
for transport and yes, Even though Penn Presbyterian Is less than a mile and
a half from our hospital At the University of Pennsylvania, We did identify that we
needed to airlift this patient Because we did not have ground assets. So we started moving the helicopter Even while they were in the CT scanner. CT was completed about a half, About 20 minutes after
arrival and then the patient Was taken right up to
the helipad for transfer. The door and door out for this patient Was around 30 minutes,
which I know, you know, We're all struggling to
get below 60 or below 90 But you know, this just shows
when we're working in parallel What kind of incredible
numbers we can get.

Patient was in the OR less than 60 minutes From when they arrived
at Presbyterian Hospital. So I mean that's just phenomenal And we were able to go on to achieve A successful TICI three revascularization. And if you can go on to the next slide, And this is just an example
of some of that feedback That we then like to provide
back to our primary centers Who transfer to us. So this just gives the highlights And is something that can then be shared Because this is really a success
of partnership of you know, Working together to identify pathways And processes that work. And because of that partnership, We were able to send this
gentleman home three days later Without deficit. That only happens with
us talking to each other, Sharing with each other, Collaborating with each other And really treating it as
as a collaborative network. And I will end there. – [Jeanie] Thanks, Michele. So we're gonna have a
short panel discussion About any questions. I'm gonna start this off
by saying there's some, You got a lot of questions
in the chat here. Do you have a monthly
standing meeting or cadence For sharing feedback on the
transfer patients outcomes? And I'm going to also bring
in our other presenters, And Kim is on here but
does not have video. So Kim and Claranne and
Erin can also chime in. But the first question from the group is, Do you have a monthly standing meeting

Or cadence of sharing feedback On transfer patients outcomes? – Yeah, so I actually send
out our transfer our data On all our telestrokes and our transfers To our partner hospitals
on a monthly basis. Which includes what happened to them, What their length of stay was, What their disposition was
after they left the hospital. And then as for standing meetings, We do have standing meetings With each of our partner
hospitals on a monthly cadence. – [Jeanie] Any questions or comments From Claranne and Erin or Kim? – I can add, we do a similar process Where we have a monthly
telestroke partner meeting. So this is with all of our
sites all together at once And then quarterly we
kind of have a little bit Of an expanded system meeting With some expanded
leadership that are included. – [Jeanie] We have an
additional question asking About what shared tool
do you use for imaging? – We're a rapid AI shop. – [Jeanie] Okay. – At Lehigh we're a Viz.ai shop. So that's another form
of AI that that is also Frequently used. – [Jeanie] Okay, we'll give
you one more question here. How is EPIC use to make a stroke alert? Is there a button? Is there easy-
– That's a good one. There's not an easy button yet And boy do we wish there were. So what we've developed is we utilize The Haiku stroke alert, which is the,

Haiku is the EPIC application That delivers emergent messages. When the patient hits one of our ERs, The Haiku alert is embedded in the order, Is embedded in the order set
for the stroke alert patients At each of our EDs. So they don't even have to think about it, They just place the order set. We placed it in the same order That you get the CTs with purposely Because they're always
going to order the CTs. So we embedded it with that order set So that it just automatically goes out. Some of our sites are using
it purely for data collection. Some of our sites like
our Hub hospital at Hup Uses it to respond to the alerts. – [Jeanie] One more question here, What is the assessment tool you use To identify ideal candidates for transfer? – That is, I guess it's
on a case by case basis. I mean we're obviously we
use the NH stroke scale When we're discussing the cases With our outside hospitals and really it, The decision comes down
to the stroke scale Or the need for thrombectomy
or higher level care. – [Jeanie] Perfect. We have additional questions
so that we will try To answer offline but
we are going to move on To our next speaker, which
is the esteemed Erin Conahan. – All right. So as Jeanie had mentioned earlier, I am going to be pinch hitting for Ken Who is serving as an NP in
our neuro IR clinic today. So I have the pleasure of
doing a mobile stroke story.

So this is at a Rite Aid
and it's I've fallen. So next slide please. Ken and I have no disclosures. And just to kind of set the stage, So with our mobile stroke unit
where we are in Pennsylvania, There are two ways that
we can be dispatched. The first is through our
Lehigh County EMS system. So they can dispatch us directly Or we have relationships
with some EMS agencies That if their truck gets on scene, They determine it's a
stroke they can call for us. So in the case we're gonna review here, This was a call that initially went out To one of our local agencies. It was an ALS fall victim. So a lot of information you get When you're going out
on these calls, right? So the responding team gets on scene And they very quickly realize
that this 83 year old who fell While she was shopping,
didn't trip over anything, Was not answering questions,
not following commands, And definitely looked like a stroke. So they called and requested
our mobile stroke unit. So our mobile stroke unit arrived, Oh we were dispatched at 13:27, sorry. And then if we go to
the next slide please. Our arrival time is 13:39. So while they're waiting
for our MSU to arrive, The local EMS agency is
getting blood sugars, Getting vital signs, Pretty much packaging the patient, That way when our team gets on site, All we do is move from
one stretcher to the next And start to load that patient for CT.

So on scene arrival time is 13:39. We quickly got a race score and race score Is a severity scale that is embedded In the EMS protocol in Pennsylvania. So once we got that race score, Get the patient loaded
for CT and while the crew Is loading the patient into
position to get those images, Our PHRN is speaking with the crew That initially responded,
getting the story, Talking to her friend who was with her While she was shopping
and then also notifying Our telestroke doc like, Hey, by the way we're
actually ready to go. So if we go to the next slide. Her images were started at 13:48. So it does take a little
bit of positioning In an 83 year old, a little kyphosis, You have to make sure that
they're nice and straight On that table just like you
do on a regular CT machine. So we were quickly able
to get those results To our neurologist to
review them at 13:50, Saw no hemorrhage, and at
this point he goes ahead And starts the tele neurology consult. Next slide, please. So telestroke consult begins at 13:50. Her last known well is 13:10. So we're talking 40 minutes From when she had the
start of her symptoms. She has no known allergies, She has a pretty
significant cardiac history. She does not take any
antiplatelets or anticoagulation. And we do weigh our patients on the MMSU And she did come in at
a 48 kilogram weight. 13:52, her NIH stroke scale

Is completed by our stroke neurologist And he gets a 20. And at 13:58 with the
information we have at this time, We determine that she's a
candidate for alteplase. So we use alteplase in
our hospital system. Now being the patient is aphasic And it's a friend that's with the patient, Our neurologist did
reach out to the family And review the plan of care And kind of what we're doing Just to make sure they were okay. So at 14:08 alteplase is administered. So I'm just gonna pause
there for a second. So last known well is
13:10, 58 minutes later, From the onset of her
symptoms, she gets drug. So it's kind of pretty amazing, right? Modern medicine. So we'll go ahead to the next slide. Because she had the race score of eight, Which signifies she's at high risk For having a large vessel occlusion, They did take her to our CSC. So arrival at the CSC is 14:21. On arrival she had no
change in her neuro exam. We got the CT angiogram at 14:26 And the official imaging read is at 14:48. So like many of you, I
imagine our, you know, Your team is in CAT scan as
it's being done and reading it, This is, you know, The official read
documented in the record. Decision to treat, to take
her to the table is at 14:59. So again, even though we
had contacted the family To get TPA, kind of started The conversation that she
might need further treatment.

At our site our
neurointerventionalists do have A conversation with the family as well. So family agreed to go
ahead with procedure. Arterial puncture is at 15:20 And at 15:48 she's recanalized. So again, just kind of thinking, 13:10 is her onset of symptoms, A little more than two
and a half hours after The symptom onset. She has TICI 2b recanalization. So if we go to the next slide. So her outcome. Radiologically, she had a good outcome. Post-procedure, she wasn't
doing very much initially. 24 hours post-procedure. We got routine imaging
like everybody does. There's no hemorrhage, no
unexpected image findings. But as the day went on, She did require additional pressors For blood pressure support. And kind of alluded to earlier
how sick her heart was. She did, despite aggressive intervention, She did go into cardiogenic shock. There were multiple
conversations with the family And they agreed at this point To transition to care comfort measures. So just kind of bringing home
the point that all of the data Shows us that the earlier
we get patients treated, Whether that be with thrombolytic Or with going to the interventional suite And pulling that clot out, Patients tend to have good
outcomes with better outcomes. But despite getting their
two and a half hours From symptom onset,

Getting good radiographical results, Unfortunately her clinical
path did not follow. So we'll go ahead and do the next slide. There are always questions about the MSU And really what does the MSU do? So just spend a couple
minutes talking about this, Not even a couple minutes. So the MSU is bringing the
neurological emergency room To the location of the patient. So we're bringing you the CAT scan, We're bringing you the specialized staff, We have the Our Stroke neurologist Via camera and tele equipment
to be able to actually, It's a four to one ratio
who's caring to this patient And the results of many of the trials That are coming out are
showing that when we look at The use of mobile stroke units, We're increasing the amount of patients Who are able to get thrombolytic, We're able to get that
to that patient faster And most patients do have a good outcome. I think the bigger question
with RMSU is not gonna be, You know, do they affect treatment? It's gonna be where is
the best place to put them To affect the most people. So if we go to the next slide, People always ask about our experience. So we are not a pure mobile stroke unit. So because we're a partnered
with an area agency, If they run out of trucks, Our team goes out on medical calls. So that's why you see the
two lines on the left. So the top line are the
stroke calls that they've done And the blue line are the medical calls

That they've done and the team is expected To perform according to standard practice For any medical emergency. And then on the right
hand side of the screen You can see our interventions to date. Again, we use alteplase in our network And then the number of patients That were able to go to the table. So I believe that kind of
wraps up the MSU story. – [Jeanie] Okay, great, thanks Erin. Let's bring our team up
for panel discussion. So I'm gonna get you started off, I'd like to know who staffs
the mobile stroke unit. – Okay, so our mobile stroke
unit is staffed by a PHRN And a CT tech that are from our hospital. And then we also have
an EMT and a paramedic That is supplied by the
agency we partner with. – [Jeanie] Perfect. Michele or Kim, any questions for Erin? – Michele, you're muted. – I can't read lips that well, Michele. – [Jeanie] We can hear you now. Nope. – Okay, now am I unmuted? Okay, sorry about that. So, Erin, yeah, I think everybody's, We always have questions with those of us Who don't utilize the MSUs. What are the capabilities
of the CT scanner? – So our CT scanner, We have a CereTom on the unit And it's an eight slice scanner. So some centers have the ability to, In addition to getting the non-con CT,

They do get a CTA right away. Our neuro interventionalists
really like having The ability to see the aortic arch, The great vessels in the neck To be able to plan their journey. With our CereTom, I don't know if you've ever seen one. The hole is extremely small And we have a larger population
in the Lehigh Valley. So, many of our patients, You can't get much below their
chin into the actual unit. So to get all those vessels
is really a struggle. – Thank you. – [Jeanie] Any questions, Kim? I know we can't see you
but I know you're there. – [Kim] No, I'm good, thank you Jeanie. – [Jeanie] Okay Erin,
there's a question here. Can you treat hemorrhagic stroke
on the mobile stroke unit? Do you ever reverse or
anything on the stroke unit? – Yeah, so we do because
we can get that CT, We can see if that
patient's having an ICH. So we do have Kcentra on the truck So we are able to
reverse any coagulopathy. We do have a point of care machine for INR If the patient would be on warfarin. And then also aggressive
blood pressure control. So we have additional medications
on our mobile stroke unit That go outside of your
traditional ALS protocol In the state of Pennsylvania. So we have nicardipine and labetalol So we're able to affect That blood pressure treatment early on. And then if the patient
would have a seizure, We also have Keppra on board

So we're able to manage
that special moment as well. – [Jeanie] And just one more question. Who makes the ultimate treatment decision For even the ischemic or
the hemorrhagic patients? Who's calling the… – Yeah. So we have, you know, we
have a PHRN and we also have, One of our PNRNs is also an stroke MP. So we all, as we're working, Kind of get that feeling are
we gonna treat or not treat, But ultimately it is a stroke neurologist Who is dialing in via camera To be able to make that decision. – [Jeanie] Perfect. Thank you so much. We really appreciate your presentation And I think we are
going to move on to Kim. – All right, here we go.
– Thank you. – [Jeanie] Kim, can you… Are you unmuted?
– Yes. Hello, everyone. I will be presenting on my
medical center, Bayhealth. We are located in Delaware, Central and southern Delaware to be exact, And we are the second
largest healthcare system. I have no disclosures. We have two main campuses, We have the Kent campus
and the Sussex campus, And we have a freestanding
emergency department in Smyrna. We are a not-for-profit healthcare system With more than 4,000 employees And a medical staff of
more than 400 physicians. We are an affiliate of Penn Medicine In regards to heart and vascular care, Cancer, orthopedics, and neurosciences.

We were quite busy, as was
everyone else, in the last year With over 100,000 emergency
department visits, 17,000 patients admitted to beds, And millions of dollars
in unreimbursed care To our patients. Next slide, Gino. So what I wanted to do
is just kind of give you A glimpse of acute ischemic stroke And the number of patients
that we do serve at Bayhealth And this is all within
the calendar year of 2022. So we are a Spoke hospital center And we cared for a combined total Between our three campuses of 382 patients With a diagnosis of ischemic stroke, Of which 77 had a large vessel occlusion Which required transfer to a
comprehensive stroke center. So here in Delaware we only have One comprehensive stroke center And that is ChristianaCare, Which would be considered
our hub of course. And that is located in northern Delaware, Specifically in Newark, Delaware. We also are very lucky to have
the Delaware Stroke System Of Care Committee and that is formed Under the Delaware
Division of Public Health And we have been in existence since 2017, Of which I have been the inaugural chair, Which Jeanie spoke of a little earlier, Just able to actually pass
that on just this year. So six years kind of overseeing that And it's been just eye-opening And just a great sense of pride. We really try to keep
our patients in state So that they can be
closer to home, of course,

And receiving that time-sensitive care. Just obviously as quick as possible. All of our hospital systems
are designated stroke centers, All being primary except for, as I stated, Our one comprehensive center Which is within ChristianaCare. Next slide, please. Okay, so I am going to
present a tenecteplase case And we actually went
live with tenecteplase Here at Bayhealth in late October of 2022. And we were first in the
state as a healthcare system And so this patient was
actually in January, So this was one of our best cases. So of course I wanted to share that one, Just a couple months ago. So just a little bit of back history, It was a 70 year old plus male, Past medical history, Hyperlipidemia, hypertension, And ischemic cardiomyopathy. The patient was on Plavix and Aspirin And he was doing just fine Until 15 minutes prior to arrival. His symptoms did include
a right-sided weakness, An aphasia, his family member did call 911 So we are happy about that, And EMS recorded him van positive In regards to aphasia and neglect. So this patient did present, excuse me, To our Sussex campus
at 9:12 in the morning And this just happened to be a weekday So the stroke alert was activated at 9:15. This patient had an NIH of 19 at 9:26. His blood pressure was fine to
proceed with a thrombolytic.

It was 174 over 84. We had a blood glucose of 125. Our neurologist was notified at 9:16. We were able to obtain a CT,
a CTA shortly thereafter, Which did show a left internal
carotid artery occlusion. With this case, I do wanna
kind of highlight the fact That we used telestroke and
at Bayhealth we normally have One stroke on-call neurologist And so that neurologist happened to be At the opposite campus that day. He was at the Kent campus So he did request that telestroke be used And we have utilized telestroke
for quite some time now. It seems as if we're always kind of Tweaking the usage of it. Just in last October we are, actually, We use the Amwell system for telestroke, But what we kind of were
able to identify was that With that new system we were only using it From 5:00 p.m. to 7:00 a.m. When our neurologists were
not, you know, on site And what was happening with nursing. And we all know with the
number of travel nurses And just staffing, you know, Just in general we were just finding That it was always kind of, you know, Someone was forgetting a step And then having a hard time logging in And things of that nature. And so what we decided to
do just this last October Was to have the cart always
brought to the bedside No matter what time of
day, day of the week, Regardless if you, you know, Just for nursing to
kind of get in the habit

Of getting it to the bedside
and getting it hooked up So that if the neurologist requested it We would be saving time. So indeed no delay with this case. Our comprehensive stroke
center Christiana was called At 9:37 and that is a metric That we collect here in Delaware And you will see that in the next slides. We were able to administer
tenecteplase at 9:46 With a blood pressure of 182 over 83 Since the patient did have
that large vessel occlusion. And the other thing that
I would kind of, you know, Like to put in this area, One thing with calling our
comprehensive stroke center, We do have rapid AI and actually
all of our stroke centers Within Delaware have rapid AI for imaging. So that makes it obviously
really, you know, Good for sharing that imaging In the shortest amount of time possible, So a decision can be made
upon transfer approval. Also what we have when we have the sense That we are going to transfer a patient Is what is known as an easy
button located in our EDs. And this easy button is
actually for LifeNet, Which is our flight system here
in Delaware with Christiana And we have been empowered
to use that easy button And it just happens to be red. So sometimes someone
will say the red button Or the easy button, We all know what that means in our ED, But we have been empowered
by Christiana LifeNet To hit that button as soon as we believe We have someone who may be transferred. You know, we have found that
it definitely saves time

To kind of start that checklist
for them to be able to, You know, dispatch and if we
decide in that 10, 15 minutes That the patient truly isn't
a candidate for transport, It's no big deal to call them and cancel And they have assured us that, you know, They would rather us hit the
button as soon as possible And if needed call them to cancel. You know, it's more of
the sense and the urgency To kind of get the ball rolling
as far as that helicopter, You know, of course being dispatched. This patient was actually
discharged at 10:15 that morning. Our door to needle was 32 minutes So we did meet our goal of 45 minutes And our door in door out is 63 minutes. So we are really proud
of that with the goal Being 90 minutes, here in Delaware, We have established internal goal For the state of 90 minutes And so we are getting better and better At that door end door out. I've had quite a few under 90 minutes. You know, I will say during
the pandemic, you know, Our door end door out, Were well over 120 minutes
so to see 63 minutes, We are all just amazed
at the great teamwork Between both healthcare systems. This patient was transferred, as stated, To our comprehensive stroke
center ChristianaCare. Next slide. And this is the feedback
report that Christiana gives All of the primary stroke
centers in Delaware, Which is so very much appreciated. As you can see, there is
every bit of information, It's very thorough in the
sense that it actually starts

With the Spokes information In regards to arrival time,
last known well and NIH, And all of that care
that actually occurred At that Spoke hospital. And then of course they
move into their care As the Hub with arrival. So I'm gonna continue on with
the arrival portion of care. So this patient did arrive at
Christiana Hospital at 10:55 And upon arrival there,
the NIH was actually 22. Their repeat non-contrast
head CT showed no bleed And that patient immediately Went to the interventional suite. The thrombectomy was performed
with an initial TICI grade Of zero and a final TICI grade of three. We also are very proud
to have our physicians Listed on these reports. It just gives a sense of ownership For both hospital systems
to be able to, you know, Discuss the care and to
just see the teamwork That is existing between our neurologist, Our neuro interventional radiologist, And our stroke neurologist, of course. A little bit below in the slide You can actually see the metrics That are provided between
both hospital systems. So we look at our ED
arrival to access center, Transfer out call time. Our goal, our target is 30 minutes And we reach that in 26 minutes
and our door to transfer To other hospital, as I stated before, Our goal is 90 minutes. We were able to do that in 63 minutes. The transfer center call to the
ChristianaCare arrival time, That we are trending here in Delaware.

We are, of course, always viewing this As an area of improvement and opportunity And in this case this was at 77 minutes. So as I said, as a stroke system of care, This is always, you know, A point of discussion on
how we can just tighten That timeframe up to
achieve tighter numbers. The next metric that you see Is the transport team bedside
arrival to leaving the bedside And that was a Delaware
metric that started years ago. All of the stroke
coordinators were talking, We meet quarterly and just
kind of decided hey, you know, How can we kind of get these
door in door out times better. One was to really kind of take a look At how long the transport
team is at the bedside And as I said, I think
this has been in place At least eight years and what we found Was that one thing that
was kind of slowing The transport team was our
IV tubing was not compatible For them to be able to take
the patient on out place And continue on to leave,
you know, for transport. And so Christiana was able to find tubing That was compatible with
what the Spoke hospitals had So that they could just kind
of grab the patient and go And not have to worry about
the compatibility to the pumps. So that has definitely helped us. In this case it was 13 minutes. I've seen that done a lot quicker, But once again this is
definitely meeting our metric Of 20 minutes and then of
course Christiana's arrival To site puncture time, It was well under the
target of 60 minutes. So, great care. This patient, the best part of this story.

So our numbers look good, you know, Great collaboration with
so many team players, EMS, Comprehensive primary stroke centers. But the best news is that
this gentleman was discharged To home in under a week
with an NIH of zero. So great work for all and I am finished. – [Jeanie] Thank you so much again. – [Kim] Oh, one last
slide just to kind of give That visual of care, excuse me. As you can see, he had
an occluded cervical ICA, And then post-procedure of
course flow was restored With that cerebral
perfusion circled in green. So great work by our
partners at ChristianaCare. – [Jeanie] Great and I'm
gonna apologize to everyone. We might go over a little bit
which we're allowed to do. So I hope everyone can hang with us. Kim, you answered most of the
questions that are coming in. I have one question for you. What video technology do you use For your telehealth assessments? Their facility uses
Zoom but they're curious To see if there's something better. – [Kim] Yes, so we are using
Amwell and I will say this, Our hiccup was, we bought the program And used our own carts. Don't do that. Buy the Amwell carts
because our IT thought That they could kind of, you know, We laugh about it all,
it's not really funny, But our IT thought that
we could rig our carts And it didn't work And we did that for maybe a year And we had so many problems
with connectivity and you know, We were meeting with Amwell weekly

So I would suggest Amwell as a company Has been very responsive, But I would truly suggest
buying the specific cart That the company offers. – [Jeanie] Great, great information. We'll take some more questions at the end, But we are going to move
on to our next discussion, Which is Claranne Mathiesen speaking About a intracranial hemorrhage case. – [Claranne] Okay. All right, thank you. So I work with Erin and Ken at
Lehigh Valley Health Network And we are a hospital
system in eastern PA. So our hospital is composed of our CSE, Which is our main campus
at our Cedar Crest site. And then we have four PSC
hospital site, Spoke sites, As well as three newly built hospitals That are in the process of preparing For acute stroke ready status. So our hospitals are as close
as a few miles down the road To as far our Dixon City
campus being the furthest, Which is about 70, 75
miles from main campus. Next slide. So I have the pleasure of
being the closing speaker And we wanted to put a little emphasis On hemorrhagic stroke transfers,
which is our, you know, Trauma equivalent where
we're gonna stop the bleed. Next slide. I have no disclosures. So a couple of stories. So typically when we see Our hemorrhagic stroke
patient presentations, Typically we see one of two presentations. So this first case is
a 73 year old patient. She is one of those,
you know, church events

Where they go sinkable at
church and have a positive loss Of consciousness come in to the hospital, Not really clear what her differential is, Not called as a code stroke. And you can see door in is at 18:00 As they wind their way
down the differential, They get that CAT scan, That CAT scan pops
positive for hemorrhage, And we're looking at
a coordination of care And a door out at 20:30. So think about that scenario, Not quite called as a code stroke But comes in about 150
minutes door in, door out, And most of you would be saying like, Wow, we've gotta get that
faster, how do we manage that? Our next slide, Another patient scenario. 52 year old gentleman comes in, He has past medical history
of high blood pressure, Some tobacco use, some alcohol, He presents by EMS with
right-sided weakness, Base arm leg, some speech difficulty. They have a last known
well of of 3:00 p.m., Elevated blood pressure, you know, He's going right down the
stroke alert workup phase, Goes to CAT scan very quickly, CAT scan pops positive
for left temporal lobe, Acute hematoma and you can
see coordination of care In that stroke alert story
alarm, goes relatively fast, Same key components that we'll talk about That are paramount to our management Of the hemorrhagic stroke patient. But you can see door
in door out 47 minutes. So when that hemorrhagic patient
comes in as a code stroke

Or stroke alert, whatever
you call it in your region, You can see that care Somewhat lines up a little bit quicker. Next slide, Gino. So our ICH care. So recently those guidelines
were just re-released. You know that there's an emphasis On getting early blood
pressure control, you know, Targeting that blood pressure
to a little bit above 130 And really looking at doing that Within the first hour
of that patient arriving So that we can again prevent
that hematoma expansion. Additionally, we're gonna be
conscious of those patients That are on anticoagulation And get that reversal
process started quickly. As Michele lead it in with
communication, you know, If we're going to be
transferring that patient, We want to be sure that we are connecting And arranging that transfer plan. So in our system for our
hemorrhagic stroke patients, Those patients typically come in On our neurocritical care team service And have consultations
with our neurosurgery team. And then again, while
we're waiting for transfer, You'll hear me talk a little
bit about what do we do With those patients while we're waiting To move those patients and
coordinate care to the ICU level. So, next slide. So one of the areas that
we are challenged with Is that ED phase of care. So after you get that
CAT scan that is positive And you're waiting for
that coordinated transfer, We wanna make sure that
we have standard work For the care and standard work

For how you're gonna connect
with the logistic planning That you need for those patients. For that bedside nurse, It's so important to
have clear communication While they're waiting for that transfer. And honestly as we've gone
through two stroke surveys In the last year, This has been an area
that's been on the radar For our friendly visitors
from the joint commission. You know, what do you
do with those patients, Who's managing those patients, And how are you measuring,
if you're meeting those needs While you're waiting for that
patient movement to happen, Whether it's the patient going
internally in your hospital To the next level to the ICU Or whether they're being
moved out of your hospital To a higher level of care. Next slide. So again, this is a very, very busy slide, So I apologize. I'm gonna walk you through
how important it is To sort of keep an eye on
how you're doing with this. So as we all know door in
door out is a core measure That our PSCs and acute
stroke ready hospitals Have to manage. But as Michele pointed out very early on, This is a partnership. So the Hub and the Spokes
need to work together And have an eye on are
we moving those patients Less than 120 minutes? If it's by the American Heart guidelines, We want that even closer
to that 90 minutes. What does that look like? And if you are using
Get With The Guidelines,

There are some ways you can benchmark. So for us, we like to keep
an eye on all PA hospitals And what's it looking like, We're moving patients
on the PA hospital front And then all stroke certified hospitals. What does that benchmark look like? And then how do we sort of
compare and break that down. So you can see the upper left-hand corner Is kind of our systems scoreboard. The far right is an example
of one of our site's boards That they would review at
their operation meeting. And then at the bottom we're using some Of that advanced reporting in
the Get with the guidelines To sort of run that report
and see how close are we To getting to under 90 minutes In those patients that need to go For a time critical therapy. In summary, over on the right hand side, Some of the things we've
worked on, you know, How do we communicate early
to our transfer center? We have a centralized transfer center And we are blessed to
have four helicopters And a critical care transport in addition To our mobile stroke truck
that's able to move our patients. We're using AI to leverage
team communication. So all of our sites, our
stroke team that is providing The coverage either in
person or using telestroke Is hooked up with the Viz.ai imaging, As well as our neuro interventional team And our neuroradiologists. So we can communicate through that. We've really narrow narrowed
down focusing on expediting Our mechanical eligible patients And our hemorrhagic patients

That are moving to an ICU level. We debrief on extended
transports for learning. So every month Erin goes
to our medevac QI meeting And she walks through these cases. Our system stroke coordinators Are encouraged to connect
with our transport team To sort of lean into
what may have happened At the time of a elongated extrication. Also, like our colleagues in
Delaware using the easy button, We are trialing that at one
of our northern campuses. And then looking at
priority transport criteria And how do we leverage communication. Additionally, we've added
tracking the use of order sets And the documentation of
vital signs and neuro checks. Next slide, Gino. All right, so transfers
need a logistical plan. In eastern PA we have
some mountainous terrain. So weather is sometimes an issue. We need to again, make sure that we, When possible, can auto deploy. We wanna use the fastest
mode of transportation And then we want to really
kind of communicate that ETA To our CSE team So that they can be ready
to accept that patient. Next slide. So plan A and plan B. So we are really blessed to have Some really forward thinking leadership In our transport team
and they've worked on Kind of creating some
interesting relationships. So you know, if the weather's good And the aircraft accepts the patient And flying is the fastest
mode of transportation That that links up and
that patient is transported

And brought to the CSC site. Now if the weather is not so good, We have worked on developing relationships With local EMS services
to pick up our flight crew Because they are geographically
at four different bases And then moving those flight
crew to sort of upsize That ALS ambulance and make
it a critical care transport. And this has allowed us to
save some time, you know, Rather than sending from
our central location out To our Spoke sites, We're able to sort of move a EMS asset That's a little bit closer. Next slide. So just in closing, door
in and door out, you know, Kind of keeping those Hubs
and Spokes wheels moving, We've found that we really
have to take a hard look. You know what happens
when that door in door out Is greater than 120 minutes. Are you reviewing those charts? Are we sending transfer
feedback to leadership? Do we sort of have an understanding
of why that was held up? What does the care look like
when that transfer is delayed? So while they're in the ED, Do we have order sets that are placed So that vitals and neuro
assessments are being carried out? And not only are the order sets placed, But are we actually
completing that monitoring. As most places, our EDs are really busy, Overcrowded, kind of chaotic. So we wanna make sure we're highlighting The specific special
needs of these patients And then making sure there's ownership Of who's directing the
care of these patients While we're awaiting transfer
in the emergency department.

You know, who's the captain of that ship? So the accepting physician
may give recommendations, But how do those recommendations Get translated into the chart So that the team kind of
knows what they're doing. Next slide, Gino. All right, so some key takeaways, right? Care at the right time, Transfer to the right level of care fast. Often for our hemorrhagic stroke patients, We're gonna require critical
care transport team. Not always is it easy to coordinate And arrange movement of patients. So this really takes, you know, A dedicated team and a lot of debriefings. I really liked what, as
Michele started this off, And she talked about how each
site is slightly different. So you have to curate a plan that really Is tailored to the individual
needs of each of the Spokes. Most EDs are not set up
to hold neuro patients For an extended time. So anything we can do to
make sure that the needs Of these patients are clearly spelled out So that we're ready to go. And then, you know, our
hemorrhagic stroke population, And I know Jeanie and and
Gino will appreciate this, This is an area that we are starting To see much more of a focus on, you know, What does the quality of care
look like for these patients And are there additional things
that we should be measuring And looking at for these patients? Next slide. All right. – [Jeanie] Thank you. If we
could bring our panel up here.

We have a few questions And since we're already over time, I'm gonna use this time
to take the questions. So, you'll see on your handout
there are some handouts With information about Stroke Month, American Stroke Month
tools that are available For your download. So please take advantage of them And take advantage of future webinars. So, I have this question I have to ask, And it might be more
than time than we need, But what's the easy button? – So an easy button is
sort of like a direct link To your transfer center. So you push that button
and you're, you know, Kind of immediately connected So that you can communicate that you have A time-sensitive patient that
you need to transport out. You know, as Kim mentioned in her setting, It's a red button. So you're hitting that hot
button to sort of go directly To get that asset online,
ready to come get your patient. – [Jeanie] There's a question. Do you guys and Ken,
thank you for joining us. We appreciate that you were
taking care of patients. – I apologize.
– No, no, we appreciate it. – I'm sure my friends did
a wonderful job for me. – [Jeanie] They did. So there's questions, Do you give feedback on all
your transferred patients Or just patients that get
procedures when they get to? – I can say I provide
feedback for everybody. – [Kim] Yes, I receive
feedback on all of our patients When they have undergone intervention.

That two slide report
that I did share with you, That may take a couple weeks
because it's a lot of work Into that, but usually within 24 hours, Unless it's the weekend, I have feedback from my
comprehensive stroke center, Christiana, as to, you
know, the care provided. – [Jeanie] And this can
go across the board here. When your patients come into a CSE, Do they go direct to neuro interventional? – So-
– Yeah. Go ahead Claranne. – Yeah, so I think that
that's a good question. It really depends on the time of day. If it's after hours, a
lot of times our patients Will touch down in the
emergency department Because we wanna make
sure everything's set up And ready to receive those patients in. And it depends how quickly we're
able to get those patients. If our patients have to
go for additional imaging, Then they will touch down in the ER And go for the additional
imaging and then come over to IR. – In our case, we have
worked out a process Where we are meeting, The stroke team is meeting the patient At the point of entry, Whether that's the
helipad, if it's a flight, Or whether that's at the
ED door if it's ground, They're making the assessment
while en route to the OR Where our IR suites now are. And if they can stop in
the ED and get imaging If they think there is a need for that. Although we are now moving
towards getting imaging On the OR table prior to the procedure If we feel like we need
re-imaging is necessary.

Usually those cases that have
had thrombolytic on board. – [Jeanie] This question's for Kim And the other people can chime in as well, But Kim, do you find
hesitancy with your staff With using telemedicine? Did they initially find it
to be an additional delay Or were they amenable to it? – [Kim] So I think it's
probably about 50-50. You know, I think everyone
understands the use of it, The fact that it saves time,
but of course, you know, It stays plugged up in one area And our alerts actually go into
one specific area in the ED And so, you know, just having to run out And go get the cart, bring
it in the room, you know. Yeah, I would definitely
hear quite a bit about that. But I think more so to be very honest, It was just difficulty with
the whole IT connection of it. So, working with your IT department And whatever company you may go with For your telestroke
system or even, you know, Your Hub hospital may provide
your telehealth equipment. I think that is really the part that staff And even as a coordinator, you know, I think that is the most crucial
part to the success of it Is just guaranteeing that it will connect And connect quickly every time. Because what we did see when
we were having difficulties With connection, you know, What happened is our docs
would just, you know, Kind of pull out FaceTime And we had to run with it in that moment. So, that's what I would
say, you know, kind of offer Is just making sure that IT is on board And there's clear communication
and realtime communication.

So, your neurologists who
are involved can't wait Until the next day to tell
somebody they had a problem. They kind of need to speak
on it because at least here, IT will come out immediately
because you have no idea When the next stroke
alert is coming, right. So yeah. – Ken is our IT, so they
call him round the clock. It's not uncommon for a three
o'clock friendly phone call From a neurologist. – [Kim] (laughs) Wow. – [Jeanie] So I think we've
answered a lot of the questions, Ken, I'm gonna have to say
that there's a ton of questions Around MSU and even
people requesting a tour. So we may have to have you
back for an encore visit, But I would like to thank on behalf Of the American Heart Association, Thank our speakers, Michele,
Kimberly, Ken, Erin, And Claranne for, really,
your continued dedication To stroke care and to the
American Heart Association. I wanna thank everyone for attending, Especially your several hundred people Who hung with us after the hour. Whatever your role is in
the assistance of care, Whether you're a stroke
coordinator or researcher, Data, direct care nurse, You all really contribute
to the optimization Of these patients' outcomes. Once you leave today's webinar, You'll receive an email
with a short survey And we would appreciate
if you would complete that And provide your feedback. You will also receive a follow
up email in 24 to 48 hours With a link to view a
recording in today's webinar. So on behalf of the
American Heart Association

And our presenters, thank
you for joining us today. I don't wanna say happy Stroke Month 'cause there's not much
happy about stroke, But thank you for your
dedication to the stroke patients And so we will honor you in Stroke Month And the upcoming nurses this week. So thank you and have a good day. – Thank you all.
– Thank you all. – [Kim] Bye-bye. – [Jeanie] Bye.

How Stroke Hub and Spokes Help in Keeping the Wheels Turning: A Comprehensive Guide

In today’s busy world, taking care of our health can often take a backseat. However, it is important to keep our bodies and minds in good condition to ensure we can continue to lead a fulfilling life. This is especially true when it comes to preventing and managing strokes, which can be potentially life-threatening. Here, we will delve into the world of stroke hub and spokes and how they can help in keeping the wheels turning towards a healthier lifestyle.


A stroke is a serious medical condition that occurs when blood flow to the brain is disrupted, causing brain cells to die. When this happens, it can lead to a range of symptoms, including difficulty speaking, weakness on one side of the body, and loss of balance. While there are many risk factors associated with stroke, including high blood pressure, diabetes, and obesity, there are also many ways we can work to prevent strokes or manage them if they do occur.

Stroke hub and spokes are one such way to help prevent and manage strokes. They are part of a larger system known as a stroke network, which is designed to provide comprehensive and efficient care for stroke patients. In this article, we will explore the benefits of stroke hub and spokes and how they can help keep the wheels turning towards a healthier life.

How Stroke Hub and Spokes Work

Stroke hub and spokes work by providing a network of specialized care for stroke patients. At the heart of this network is the stroke hub, which is typically a hospital or medical facility that has the resources and expertise to provide advanced stroke care. This may include specialized equipment, such as MRI machines and CT scanners, as well as a highly trained medical staff that is experienced in treating stroke patients.

Surrounding the stroke hub are the spokes, which are typically smaller medical facilities that are equipped to provide initial stroke assessments and treatments. These may include local hospitals, clinics, or urgent care centers. The purpose of the spokes is to provide timely and efficient care to stroke patients, allowing them to receive treatment as quickly as possible.

The stroke hub and spokes work together to provide a seamless system of stroke care. When a stroke patient arrives at a spokesperson facility, they are assessed and stabilized before being transported to the stroke hub for more advanced care. This ensures that stroke patients receive the right care, at the right time, and in the right place.

Benefits of Stroke Hub and Spokes

There are many benefits to having a stroke hub and spokes system in place. Some of the most significant benefits include:

  • Improved Access to Care: With a stroke hub and spokes system, stroke patients have access to specialized stroke care, regardless of where they live. This means that even those in remote or rural areas can receive timely and efficient care.
  • Faster Treatment: When stroke patients receive treatment quickly, they have a better chance of recovering fully. The stroke hub and spokes system is designed to provide rapid assessment, stabilization, and transport to the stroke hub, ensuring that stroke patients receive treatment as quickly as possible.
  • Better Outcomes: When stroke patients receive timely and appropriate care, they have a better chance of having a positive outcome. The stroke hub and spokes system is designed to provide comprehensive and efficient stroke care, leading to better outcomes for stroke patients.
  • Cost-Effective: By providing specialized stroke care at the stroke hub, the system ensures that stroke patients receive the right care, at the right time, and in the right place. This can help reduce healthcare costs by avoiding unnecessary hospitalizations.


A stroke is a serious medical condition that requires specialized care. With a stroke hub and spokes system in place, stroke patients have access to timely and efficient stroke care, regardless of where they live. The stroke hub and spokes network is designed to provide comprehensive and efficient care for stroke patients, leading to better outcomes and improved quality of life. By working together, stroke hubs and spokes help keep the wheels turning towards a healthier future.


  1. How do stroke hubs and spokes differ from traditional stroke care?
  • Stroke hubs and spokes provide a comprehensive and efficient system of care, while traditional stroke care may be fragmented or more difficult to access.
  1. Who is involved in a stroke hub and spokes network?
  • A stroke hub and spokes network typically involves hospitals, clinics, urgent care centers, and other medical facilities.
  1. Is a stroke hub and spokes network available everywhere?
  • Stroke hub and spokes networks may not be available in all areas, but they are becoming more common as awareness grows about the benefits of specialized stroke care.
  1. How can patients and families learn more about stroke hub and spokes?
  • Patients and families can learn more by talking with their healthcare providers or visiting the websites of stroke treatment centers in their area.
  1. Are there any potential drawbacks to the stroke hub and spokes system?
  • While stroke hub and spokes systems have many benefits, some potential drawbacks may include increased transportation costs for patients and longer wait times for treatment in rural areas. However, these can be mitigated with careful planning and coordination within the network.