Accessible stroke care across Minnesota is what Christopher Streib, MD, MS, a stroke neurologist with University of Minnesota Physicians (M Physicians), envisioned when building a telehealth stroke (telestroke) program.
He got the idea of launching this program after witnessing challenges for patients in rural areas who need specialty stroke care.
“When I began working here, a family from northern Minnesota drove four hours to come to my clinic. They certainly didn’t want to drive that far, but there are no stroke specialists where they lived,” explained Dr. Streib, who is also an associate professor and vascular neurology division director for the University of Minnesota Medical School. “They were stressed by the traffic and being in the city, but they came because he had had three strokes in the last six months and they were, rightfully, very scared that he could have another stroke at any time.”
When Dr. Streib saw the patient, he discovered a critical blockage in his carotid artery that they immediately treated. Fortunately, the patient did not have another.
The fundamental goal that guides Dr. Streib and his team is for all stroke patients to be cared for by a stroke specialist, regardless of geographic location.
The telestroke program’s bedrock is providing 24/7 coverage by a stroke neurologist for patients arriving at hospitals in the Twin Cities and Greater Minnesota, including communities in Princeton, Grand Rapids, Wyoming and Hibbing. This infrastructure addresses a gap in stroke care, where the first 24 hours are most important, as the nation faces a critical shortage of stroke specialists.
How the Stroke Program Works
Under Dr. Streib’s leadership, the telestroke program’s work is centralized at the University of Minnesota Medical Center and M Health Fairview Southdale Hospital. From there, the stroke specialist team, including stroke physicians, fellows and advanced practice providers, connects with partner hospitals at any time of day through specialized carts equipped with audiovisual technology. The carts are wheeled into the patient’s room in the emergency department.
Every time a patient with stroke symptoms arrives at a participating hospital, the in-person emergency medicine physician and the telehealth University stroke neurologist evaluate the patient together and determine the treatment plan.
Dr. Streib says that most patients can stay in their community and be with their families while still accessing specialty stroke care from the M Physicians stroke team. The mobile telestroke carts are moved throughout the hospital to provide continuing stroke care throughout each patient’s stay. The program started with a few hospitals using telestroke care in both the suburbs and in Grand Rapids, Wyoming and Hibbing. Now, the program has expanded across Minnesota, allowing patients from the most rural areas to see a stroke neurologist and get top of the line stroke care.
“Every patient, unless they refuse and leave the hospital against medical advice, that comes into our system will see a specialist from our M Physicians team who will see the patient and review all of their tests and scans,” Dr. Streib says. “We see thousands of stroke patients each year.”
While the process of implementing this program may seem straightforward, it required building reliable technology, standardized treatment plans and communication processes among teams and hospitals. The M Physicians stroke program works directly with partner hospital information technology, nursing and physician teams to ensure the program and its technology are always functioning reliably.
The benefits for patients, physicians and hospitals speak for themselves.
M Health Fairview Grand Itasca Clinic and Hospitals in Grand Rapids, Minn., recently became one of the only telestroke hospitals to receive Primary Stroke Center certification from the Joint Commission, the regulatory body that accredits hospitals nationwide.
“It is extremely rare for a hospital without on-site stroke neurologists to become a Primary Stroke Center,” Dr. Streib says. “Especially a very rural hospital. They provide excellent stroke care, and we are incredibly proud of this achievement. This will have a major impact on stroke care in Northern Minnesota.”
Dr. Streib hopes to continue expanding the telestroke program and gathering more data to support research and funding. His vision for making this service available to more Minnesotans and patients across the region is what keeps him from sitting still on it.
“We believe in this,” Dr. Streib concluded, “And so do the hospitals we partner with. We're continually growing—adding providers, adding sites, and adding capabilities. We will continue to push the boundaries of best stroke care. It is the right thing to do.”