May 19, 2021

The need for speed: Fast stroke treatment saves lives

When a stroke happens, minutes matter, and Kaiser Permanente Stroke EXPRESS patients receive clot-busting medication more than twice as fast as the national average.

For Kaiser Permanente member Bob Wilms, it was a November Sunday morning like many others: The 69-year-old had played 18 holes of golf and then went home to watch the 49ers game at his home in Cupertino, California.

But when he woke up from a brief nap during the game, he experienced double vision and one side of his face was numb.

His wife, Vickie, immediately drove him to the Kaiser Permanente Santa Clara Medical Center Emergency Department. After being evaluated by a neurologist via video conferencing, Wilms was diagnosed as having a stroke and received a shot of alteplase (also known as intravenous r-tPA), the only medication approved by the U.S. Food and Drug Administration to treat acute ischemic stroke. This all happened within 22 minutes of Wilms’ arrival at the hospital.

“Within minutes of getting the infusion, everything started to come back,” said Wilms, a retired college admissions officer. “It literally resolved the whole thing.”

‘Get With The Guidelines’ award

Kaiser Permanente stroke patients receive the clot-busting medication r-tPA more than twice as fast as the national average. Recently, 38 Kaiser Permanente medical centers — in Northern California, Southern California, Oregon, and Hawaii — were recipients of a 2020 Gold Plus Quality Award from the Get With The Guidelines-Stroke program of the American Heart Association/American Stroke Association. The program analyzes more than 2,000 hospitals in the United States, recognizing those that demonstrate consistent adherence to the latest scientific treatment guidelines for stroke.

Wilms’ fast recovery is due to Kaiser Permanente’s adoption of an integrated, neatly choreographed telehealth program, which begins when paramedics or other medical staff provide advance notification that a stroke patient is on the way. Emergency department staff then align their efforts.

  • Pharmacy staff prepare clot-busting medications early so they’re ready to go when the patient needs them.
  • An on-call, specially trained stroke neurologist uses videoconferencing to examine the patient with a telestroke cart, which includes a video camera, and link to test results and the patient’s electronic health record.
  • A radiologist quickly reads neuroimaging studies.
  • The stroke alert team reviews a checklist to ensure r-tPA can be administered safely.
Doctor examines stroke patient on computer screen

Patient receiving remote telestroke care.

“When a stroke happens, minutes matter,” said Mai Nguyen-Huynh, MD, MAS, vascular neurologist and research scientist with the Kaiser Permanente Division of Research. “Faster treatment with r-tPA, which dissolves the stroke-causing clot and restores blood flow to the brain, is strongly associated with better functional outcomes for stroke patients.”

The AHA/ASA guidelines recommend “door-to-needle” times of 60 minutes or less for r-tPA. Studies show that less than 30% of acute ischemic stroke patients in the United States are currently being treated within this window. But in Kaiser Permanente’s 21 Northern California hospitals, door-to-needle times for r-tPA averaged just 34 minutes within 9 months of implementing the telestroke protocol.

“Processes that used to happen sequentially during a stroke alert, one after another, are now happening at the same time, allowing us to quickly, safely, and confidently provide evaluation and treatment with r-tPA to stroke patients who can benefit,” said Jeffrey Klingman, MD, chair of chiefs of neurology for Kaiser Permanente in Northern California.

“When minutes count, Kaiser Permanente’s telestroke model delivers,” explained Navdeep Sangha, MD, who leads telestroke efforts in Southern California. “For our patients, our coordinated process provides precious time to receive potentially life-saving care for an ischemic stroke.”

‘Like watching an orchestra’

After being in the hospital for 4 days so the staff could closely monitor his recovery, Wilms was given the all clear to go home.

He now plays golf every day and hikes as if “nothing ever happened.”

“Thanks to the folks at Kaiser Permanente, I’m still alive,” said Wilms.

Vickie Wilms also commented on her husband’s excellent care.

“Even though I was in shock, it was an incredible experience to watch. All the staff members who assisted him were so synchronized and knew exactly what to do. It was like watching an orchestra. Everyone knew the steps to take to save my husband’s life.”