MUSC, Roper St. Francis announce novel partnership in creation of Lowcountry Stroke Collaborative

October 28, 2016
Stroke Collaborative Cawley
Dr. Patrick Cawley says the partnership with Roper St. Francis is an innovative way to rise above what can be a competitive health care climate. Photos by Sarah Pack.

If the telling phrase of the day was win-win, the emotion that best captures the announcement of a partnership between two leading hospitals to create a Lowcountry Stroke Collaborative would be giddy.

That’s because today marked the joint celebration of the partnership between the Medical University of South Carolina and Roper St. Francis in what is being hailed as a highly unusual collaboration between two institutions that generally compete.

That wasn’t causing the most excitement, though. The partnership means that Roper St. Francis and MUSC Health, which in December 2015 was recognized by the Joint Commission as a comprehensive stroke center –  its top certification, will be pooling resources to work as a team, using telehealth and other innovative collaborations to reduce barriers to stroke care while improving the quality of treatment.

For stroke experts and surgeons at both institutions who know firsthand why “time is brain,” this is a dream come true and one that some doubted would ever be realized.

Erin Sparks, M.D., a neurohospitalist at Roper St. Francis who trained at MUSC, said it’s a win-win situation. “We’re over the moon – we’re very thrilled to be a part of this and to be able to make this happen. We’re very good at what we do, but now that we have the potential to offer the very latest in stroke care, this puts us on par with one of the leading academic institutions in the country.”

Listing stroke symptoms to the crowd that gathered for the press conference to announce the partnership, Sparks explained why time matters so much.

“Having a stroke is absolutely terrifying,” she said. “When you’re having a stroke, every single minute matters. One-point-nine-million neurons or brain cells are destroyed each minute that passes when you’re having a large stroke. This is why we say time is brain. When literally every minute counts, you want to be able to make the right treatment decisions as soon as possible.”

In the past, this would have meant a patient who was possibly having a stroke would come into the emergency department, and then a neurology consult would be requested. Now, physicians and nurses have been trained to use MUSC’s telestroke carts. A neurologist can log onto the system and evaluate a patient within minutes.

“Think about it,” she said. “The difference in time can save a person’s ability to speak and move their arms. This is why this partnership is so important. Having this technology now allows me to see a patient face-to-face within minutes of their presentation no matter where they are in our hospital system – Roper Mt. Pleasant to our free-standing ERs at Roper at Northwoods, at Berkeley, to Roper St. Francis and here at Roper downtown.”

Roper doctors will handle the telestroke calls during the day for their locations, but MUSC Health and Roper doctors will share calls at night to ensure 24-hour care at all of the sites. Research shows that this kind of expert access improves treatment decisions, including the call of whether to administer the clot-busting medication tPA, which affects door-to-needle times. There’s a critical window of time for stroke patients to be eligible for intravenous tissue plasminogen activator to have the best outcomes.

It took a village of people months of work and training to make the partnership become a reality, but two key players in making the dream come true were Sparks and Christine Holmstedt, DO, medical director of MUSC Health’s Comprehensive Stroke Center and telestroke program.

“I’ve worked with many folks around the state to develop what we call the South Carolina Telestroke Alliance,” Holmstedt said. “This alliance has allowed rural hospitals access to expert stroke care. We currently cover 96 percent of the state, so 96 percent of the state has immediate access to emergent expert stroke care.”

The numbers speak for themselves. When the telestroke program began in 2008 there were 87 consults. By 2016, this number had risen to 2,040. For years Holmstedt and colleagues have been working to build this program around the state. But Holmstedt said she’s always had a secret dream of bringing it back to the Lowcountry.

“We knew it was possible but it was going to take a little bit of convincing, a little bit of discussion, a little grassroots.”

She and Sparks met several times and brought it up to administrators. Both said they have been pleasantly surprised by the enthusiastic response of administration. Holmstedt said the advantages in cost savings and patient care made it worth the while to figure out how to make such a partnership work.

“The biggest advantage to having a Lowcountry Stroke Collaborative is that it allows folks to be seen within minutes of having a stroke. Every 15-minute reduction in treatment time means improved outcomes for patients including reduced risk for complications and disabilities. That’s why we feel this partnership is so important.”

The partnership will continue to grow. Holmstedt said they hope to set up clinics focused on preventing cardiovascular disease and reducing the prevalence of stroke. It also makes collaborative research projects easier that will offer an array of options for stroke prevention and treatment. South Carolina is part of the Stroke Belt, an 11-state region of the United States where studies show the risk of stroke is 34 percent higher for the general population than it is in other areas of the country.

“It’s the most exciting thing we’ve done in our stroke program so far, and we’ve done a lot of exciting things,” Holmstedt said. “It’s going to improve patient care that much more throughout the Lowcountry. I’m really excited to get started. It’s going to level the playing fields among all our sites. The goal is that patients will receive the same level of care no matter where they go.”

Raymond Turner, M.D., a neurosurgeon and director of MUSC Health’s Cerebrovascular Center, said in January they will phase in the next part of the plan that will eliminate transfers between the hospitals of stroke patients who need specialized surgical care. This will mean MUSC Health physicians will travel to other hospitals to take care of the stroke patients there, eliminating 20 to 30 minutes that would be involved in getting that patient transferred.

“We fight every day to save 5 minutes here and 10 minutes there in patients getting access to tPA and stroke comprehensive services,” he said. Eliminating delays in access to treatment gives the patient more treatment options and a better chance of survival with the fewest limiting disabilities. 

“We’re excited that we’ll be able to offer that at Roper and St. Francis, and that we’ll be able to be on site quicker and faster than we have ever been able to do before. That’s an exciting paradigm, and it will really change the way patients have access to stroke care.”

Pat Cawley, M.D., MUSC Health chief executive officer, said the partnership marks an innovative way to rise above what can be a competitive health care climate.

“These two institutions, which are right across the street from each other, compete in many different areas. Today, we’re announcing a unique collaboration. I think that’s great news in and of itself that two great institutions are working together,” he said. “More importantly, this great collaboration is going to lead to improved care in the community. That’s the real win here today.”

Cawley said the state has invested in telehealth and in having MUSC Health work with other health systems to help deliver telehealth through South Carolina. “We think this is going to be a big game changer for the entire state.  We’re going to be able to bring cutting edge care closer and closer to patients and families. Today is one such example of a telehealth practice.”

Matt Severance, Roper St. Francis chief operating officer, agreed with Cawley, adding that unfortunately, in today’s modern era there are not many examples of competing institutions finding ways to collaborate.

“The partnership is a great example of two health systems that are otherwise in a competitive environment coming together for what’s best for the community. We’re leveraging the collective resources of two institutions, the collective clinical expertise and the collective technology, to both improve and expand stroke care not only in the region but across the state.”

However, it’s not the first time the two institutions have worked together. He cited plans for a greenway – a new medical district that will offer a healthy green space. The hospitals also have successfully worked together to provide the Center for Spinal Cord Injury.

Severance likes that the Lowcountry Stroke Collaborative means patients will be seen and treated more quickly than ever before. “We’re partnering with the Medical University to ensure stroke patients receive timely care at a location capable of providing specific services and clinical expertise that they need most. It’s a huge win for the patients and the providers. The collaboration will lead to better care for patients, improve the outcomes, decrease costs and mean fewer transfers from facility to facility.”

Sparks said another benefit of the partnership is that it opens up training opportunities for Roper health professionals, from everything to having access to grand round educational presentations to specialized trainings. The partnership helps patients and providers in a collaborative model that has the potential to change how health care is delivered.

“It’s unusual for an academic institution and a private institution to collaborate on a project this big. While people around the Lowcountry are excited about this, people around the country and even around the world are watching this to see if we will succeed. It will be a model for the country.”