MUSC background

Improving Access to Timely Acute Stroke Care

The REACH MUSC program, an outreach initiative in which MUSC acts as the hub of stroke neurology expertise for 12 spoke hospitals, was established in May 2008 to increase rural South Carolina residents’ access to expert stroke care within the required time windows for the administration of tissue plasminogen activator (tPA). Timely administration of tPA can improve the clinical outcomes of some patients with ischemic stroke, “saving brain” and reducing stroke-related disability.

Since the program was established, the percentage of South Carolinians living within 60 minutes of expert stroke care has increased from 38% to 76% (Kazley AS et al. Front Neurol 2012;3:44. doi: 10.3389/ fneur.2012.0004). “That is a massive increase in access in a few years—representing almost a million to million and a half people,” notes Robert J. Adams, M.D., Director of REACH MUSC.

The REACH cart allows the stroke neurologist to not only communicate directly with the patient and the local physician through video teleconference but also to access the patient’s computed tomographic scan and other records to facilitate the decision whether to administer tPA. The program achieves response times that would be inconceivable without telehealth. According to Dr. Robert Adams, “To have a stroke neurologist in the emergency room in nine to ten minutes could only happen with telehealth. When you see this in action, you realize this is the way nonsurgical specialty care will be handled more and more in the future because you can’t compete with those response times unless you station someone full time in the emergency department, which is not feasible.”