title: Description of a novel telemedicine-enabled comprehensive system of care: drip and ship plus drip and keep within a system of stroke care delivery.
abstract: United States (US) and worldwide telestroke programs frequently focus only on emergency room hyper-acute stroke management. This article describes a comprehensive, telemedicine-enabled, stroke care delivery system that combines "drip and ship" and "drip and keep" models with a comprehensive stroke center primary hub at Ochsner Medical Center in New Orleans, advanced stroke-capable regional hubs, and geographically-aligned, "stroke-ready" spokes. The primary hub provides vascular neurology expertise via telemedicine and monitors care for patients remaining at regional hubs and spokes using a multidisciplinary team approach. By 2014, primary hub telestroke consults grew to ≈1000/year with 16 min average door to consult initiation and 20 min to completion, and 29% of ischemic stroke patients received recombinant tissue-type plasminogen activator (rtPA), increasing 275%. Most patients remained in hospitals close to home, but neurointensive care and interventional procedures were common reasons for primary hub transfer. Given the time sensitivity and expert consultation needed for complex acute stroke care delivery paradigms, telestroke programs are effective for fulfilling unmet care needs. Combining drip and ship and drip and keep management allows more patients to stay "local," limiting primary hub transfer unless more advanced services are required. Post admission telestroke management at spokes increases personnel efficiency and can positively impact stroke outcomes.
authors.affiliation: 1 Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Commiskey
authors.affiliation: 2 Ochsner Medical Center, New Orleans, LA, USA.
authors.forename: Arash
authors.initials: A
authors.lastname: Afshinnik
authors.affiliation: 2 Ochsner Medical Center, New Orleans, LA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cothren
authors.affiliation: 3 University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Toby
authors.initials: T
authors.lastname: Gropen
authors.affiliation: 2 Ochsner Medical Center, New Orleans, LA, USA.
authors.forename: Ifeanyi
authors.initials: I
authors.lastname: Iwuchukwu
authors.affiliation: 2 Ochsner Medical Center, New Orleans, LA, USA.
authors.forename: Bethany
authors.initials: B
authors.lastname: Jennings
authors.affiliation: 2 Ochsner Medical Center, New Orleans, LA, USA.
authors.forename: Harold C
authors.initials: HC
authors.lastname: McGrade
authors.affiliation: 4 American Heart Association, Metairie, LA, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Mora-Guillot
authors.affiliation: 2 Ochsner Medical Center, New Orleans, LA, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Sabharwal
authors.affiliation: 2 Ochsner Medical Center, New Orleans, LA, USA.
authors.forename: Gabriel A
authors.initials: GA
authors.lastname: Vidal
authors.affiliation: 2 Ochsner Medical Center, New Orleans, LA, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Zweifler
authors.affiliation: 2 Ochsner Medical Center, New Orleans, LA, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Gaines
mesh_terms: D004636:Emergency Service, Hospital; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020521:Stroke / Q000188:drug therapy*; D017216:Telemedicine / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Stroke care delivery; telestroke program