FL Health System Launches Telehealth

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By Anuja Vaidya

June 06, 2023 - University of Florida Health (UF Health) has launched a mobile stroke unit that leverages telehealth to improve stroke care.

The mobile stroke units include a diagnostic computerized tomography (CT) scanner, medications to mitigate clots resulting from strokes, such as Tenecteplase (TNK) and tissue plasminogen activator (tPA), medications given intravenously to lower high blood pressure, medications to reverse the effects of bleeding inside the brain, and telemedicine equipment.

UF Health and Alachua County Fire Rescue personnel will staff the units. They will include a stroke-trained nurse, a CT technician, an emergency medical technician driver, a paramedic attendant, and a stroke neurologist, who will be available virtually via telehealth.

By launching the mobile stroke units, the health system aims to expand access to stroke treatment and initiate it sooner. The units will allow healthcare professionals to diagnose and treat stroke patients while on their way to a stroke center.

Research has shown that quicker stroke treatment can boost patient outcomes significantly. Stroke patients receiving medication within 60 minutes of the onset of symptoms experience improved long-term outcomes. This is known as the 'golden hour' in stroke treatment.

"Stroke is the fifth leading primary cause of death and a leading cause of long-term disability in people," said Anna Khanna, MD, medical director of the UF Health Shands Comprehensive Stroke Center and an assistant professor of neurology at the UF College of Medicine, in the press release. "With this new unit, we will bring the treatment to the patient instead of waiting for the patient to arrive at the hospital for care. This reduction in time from onset of symptoms to treatment will not only save lives, but will reduce the amount of disability people have when they survive a stroke. This has a tremendous impact in terms of ongoing quality of life."

The health system will deploy the mobile stroke unit in cooperation with Alachua County Fire Rescue by the end of July in Gainesville, Florida. It also plans to add units in The Villages, Florida, and Jacksonville, Florida.

The units' launch and operation are being supported by philanthropy, including a $1.5 million commitment from an anonymous donor and a $1 million contribution from UF Health The Villages Hospital Auxiliary Foundation.

Providers are increasingly employing telehealth-enabled stroke care to widen healthcare access.

In January, Stephens County Hospital, a 96-bed hospital in Toccoa, Georgia, announced a partnership with Wellstar Health System, a nine-hospital system, to expand stroke care by adding virtual care consultations. Through remote consultations, the vascular neurology team at Wellstar Kennestone Regional Medical Center will support Stephens County Hospital staff in providing stroke care.

But the evidence backing telestroke services is mixed. While these services can enable faster treatment, they may not move the needle on patient outcomes significantly.

A study published in 2019 showed that mobile telestroke units deployed by NewYork-Presbyterian Hospital reduced time-to-treatment by 30 minutes on average. The study, which assessed data from the METRONOME (Metropolitan New York Mobile Stroke) registry, revealed that 29 of 66 patients in the mobile stroke units were treated more quickly than nine of the 19 patients taken to the hospital by an ambulance.

According to a more recent study, however, telestroke adoption in hospitals did not change patient outcomes or stroke systems of care.

Researchers compared 593 hospitals that adopted telestroke between 2009 and 2016 with 593 control hospitals that did not. They found that the distances patients traveled to reach the hospitals increased slightly from pre- to post-implementation in both hospital groups. Additionally, both groups had similar 180-day mortality rates and saw an increase in the proportion of stroke patients transferred to another hospital after telehealth implementation.