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Adapting and Adopting the Right Tools to Maintain Quality, Comprehensive Stroke Care During a Pandemic

A study published last year in the New England Journal of Medicine suggested that the number of patients seeking care for severe stroke symptoms at U.S. hospitals dropped by almost 40% in the early months of the pandemic. This delay or avoidance of medical care has, fortunately, begun to subside now that case counts are down and vaccinations are up. A positive shift considering what we, as providers, have known all along: medical emergencies and chronic health problems did not disappear with the onset of COVID-19, says UVA neurologist Necrisha Roach, MD.

“Patients are still having heart attacks and strokes; babies are still being born,” says Roach. The need for emergent care hasn’t changed; what has changed, however, is the way we deliver it.

At the UVA Stroke Center, which has been recognized for its rapid stroke response and specialized intervention techniques, care teams implemented new safety protocols to treat all patients, including those who had a stroke as a result of COVID-19 complications.

“It was not uncommon for us to have a patient admitted to the COVID unit who suffered a stroke and needed to be evaluated by a neurologist,” says Roach. “Instead of the physician coming in and putting on PPE and risk being exposed to the virus, we came up with another solution.” 

That solution was telemedicine, which UVA has used for more than a decade to serve patients in rural communities. “With the help of our bedside nurses and doctors in the COVID unit, I can do an entire stroke assessment remotely, provide the best treatment recommendation for that patient and monitor them at regular intervals,” says Roach. 

Utilizing existing technology in a new way is just one example of how UVA care teams quickly adapted so they could continue to provide timely, effective diagnosis and treatment. For stroke patients, this meant the difference between serious deficits and a full recovery, life and death.

The Merits of a Comprehensive Stroke Center

Providing unparalleled stroke care — 24 hours a day, seven days a week — UVA Stroke Center is Charlottesville’s only Comprehensive Stroke Center. This designation is the highest level of recognition awarded by the Joint Commission, and only the top 2% of stroke centers nationally have earned it.

What does this certification mean to patients? It means a hospital is ready at any time to deliver the most advanced care available for stroke and stroke complications. Comprehensive Stroke Centers are the only stroke centers to offer: 

  • Care for all types of stroke, including hemorrhagic 
  • 24/7 access to minimally invasive catheter procedures for stroke 
  • 24/7 on-site neurosurgical availability with the ability to perform complex neurovascular procedures, such as brain aneurysm clipping, vascular malformation surgery and carotid endarterectomy 
  • Dedicated neuroscience intensive care unit 
  • Accepts patients transferred from primary stroke centers
  • Active participation in IRB stroke trials 

UVA Stroke Center: Facts at a Glance 

  • More than 90% percent of patients who arrived at UVA Emergency Department within two hours of last-known well and who were eligible for treatment with tPA were treated by the three-hour mark 
  • A board-certified vascular neurologist oversees the acute stroke intervention team during admissions and inpatient stroke service 24/7 
  • Nerancy Neuroscience Intensive Care Unit (NNICU) staffed 24/7 by a neuro-intensivist 
  • Endovascular treatment for stroke available 24/7 
  • Received 2019 Get With The Guidelines-Stroke Gold Plus Achievement Award; made the Target: Stroke Honor Roll-Elite 

Telestroke Means a Broader Reach

The UVA Telestroke program provides partner community hospitals and their patients advanced neurological support, which is available remotely throughout the Commonwealth using videoconferencing technology.

The experienced Telestroke team supports community hospitals by: 

  • Providing urgent medical assessments to determine the likelihood and severity of a stroke. 
  • Helping determine the best course of treatment, with access to evidence-based treatments, including IV thrombolytics and innovative clot-retrieval procedures. 
  • Facilitating transfers to the UVA Neuro ICU and Stroke Unit for acute stroke patients when needed, and providing ongoing neurologic consultation when transfer is not necessary. 
  • Communicating directly with the patient and their family once the patient is stabilized: explaining the clinical evaluation, treatment options and prognosis and allowing ample time to answer questions and address concerns, reducing the burden on the community hospital staff. 
  • Offering emergent consultations for all neurological subspecialties. 
  • Providing specialized online and on-site training to help providers and their patients quickly recognize the signs and symptoms of stroke, saving valuable time.

Furthering their outreach efforts, UVA has led the development of iTREAT (Improving Treatment with Rapid Evaluation of Acute stroke via mobile Telemedicine), a mobile technology solution being researched that allows EMS personnel to correspond with our Acute Stroke Team in the evaluation and treatment of stroke patients.

Commitment to Research 

Our stroke research and clinical trials focus on three areas: interventional acute stroke clinical trials, telestroke systems and preventative genetics. 

A Skilled Stroke Team

Members of the UVA multidisciplinary stroke team are on the front lines at UVA Medical Center 24 hours a day, seven days a week, receiving and treating patients in the Emergency Department, Stroke Unit and NNICU. 

A separate team staffs the UVA Telestroke program around the clock, ensuring that when a suspected acute stroke case comes in to a partnering hospital, the team is ready to provide the care that patients need.

To refer a patient to UVA Health, call UVA Physician Direct at 800.552.3723.

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