From telehealth collaboration to advanced interventions: Novant Health’s systemwide strategy for rapid stroke response

Novant Health is a leader in stroke care across North Carolina, setting the standard by rapidly reducing response and treatment times. The health system operates three Comprehensive Stroke Centers statewide: Novant Health Forsyth Medical Center in Winston-Salem, Novant Health Presbyterian Medical Center in Charlotte and Novant Health New Hanover Regional Medical Center in Wilmington. Each center is staffed with expert emergency neuro specialists, including stroke neurologists, neurosurgeons, interventional neuroradiologists and advanced practice practitioners who handle complex cases — from emergency treatment of large vessel occlusions during acute strokes to brain tumors and traumatic brain injuries.

What does industry-leading response time look like?

“The Forsyth Medical Center team now averages just 20 minutes to administer a thrombolytic, in part due to a recent switch from alteplase to tenecteplase for tissue plasminogen activators,” said Colin T. McDonald, MD, medical director of the Comprehensive Stroke Program at Forsyth Medical Center. “This is 10 minutes faster than the top standard set by the American Heart Association’s guidelines. All three comprehensive stroke centers meet or exceed standards.”

Additionally, Novant Health and its medical and emergency centers have earned national recognition for stroke care, receiving the Million Hearts Health System Award for advancing community health and health equity and the Get With The Guidelines–Stroke: Gold Plus award for consistently delivering evidence-based, coordinated care that improves outcomes and recovery and reduces readmissions.

Implementation of AI-assisted triage and telehealth collaboration

Novant Health provides inclusive and equitable access to telestroke services. This enables all three Comprehensive Stroke Centers to receive referrals and patient transfers from regional partner sites.

“Novant Health stroke centers accept patient transfers from referring hospitals based on stroke activation criteria and code neuro protocols. Through Viz.ai, care is expedited. Care teams across sites collaborate with referring centers during the acute phase of diagnosis and treatment.”

Viz.ai software has an artificial intelligence capability to detect large vessel occlusions, hemorrhagic strokes and more, said Tom Curley, manager of the stroke and neuro program at New Hanover Regional Medical Center and the Novant Health Coastal Region. “Our neurologists can see images such as CT scans immediately and notify the sending facility via the app’s secure chat feature that we either need to get the patient here stat for treatment, or they can treat the patient in their local facility.”

Ultimately, if specialized treatment is needed, patients can be transferred to a nationally certified Novant Health stroke center for advanced care. In this case, Lakshminarayanan said, “We communicate with the referring centers on a regular basis via monthly data sharing and quarterly team meetings. We also share formal updates between meetings as necessary.”

24/7 operation allows treatments to begin sooner

Novant Health Comprehensive Stroke Centers are equipped with neurointerventionalists, neuroradiologists, neurologists, neurosurgeons and advanced practice providers who are available 24/7.

At Forsyth Medical Center, the key differentiator for rapid response times is the availability of a neurohospitalist and rapid response team with a dedicated neurology ICU RN available around the clock. A team of dedicated neurohospitalists is assigned to the emergency department for 24/7 coverage.

New Hanover Regional Medical Center’s offerings keep rural patients closer to home. The Novant Health Neurosciences Institute (NSI) - New Hanover in Wilmington contains the Comprehensive Stroke Center as well as three patient care floors, four dedicated operating rooms, intensive care and step-down units, plus two interventional suites equipped with biplane imaging. When the NSI opened in February 2023, it was one of the first centers to utilize BrainLab, AEOS exoscope and hybrid OR capabilities.

Presbyterian Medical Center features a neuro ICU, a neuro stepdown unit and a stroke neurosciences unit. Additionally, Presbyterian Medical Center offers follow-up support for patients with limited resources, including travel vouchers and 30 days of free medication.

Strong collaboration with EMS

Each center emphasizes rapid communication and handoff from EMS to hospital care teams. All processes, including the activation of a code stroke from the field by EMS, start before a patient arrives at the emergency department so the care team is ready upon arrival. The patient is met in the emergency room by the stroke team.

New Hanover Regional Medical Center, Presbyterian Medical Center and Forsyth Medical Center received a federal grant to provide advanced stroke life support training to their EMS agencies, so teams know exactly where to transport patients. Team members across the system educate the rural communities about how to identify a stroke and make the time-sensitive call to 911.

At Forsyth Medical Center, highly trained EMS staff pre-notify the team so stroke rapid responders are waiting on arrival for incoming stroke patients. Once admitted, patients are moved straight to the CT room where the entire workup is performed.

The Presbyterian Medical Center process is similarly robust. "We pre-register the patient so they are in the system when they reach the door," said Annabelle Black, manager of the stroke and neuro programs in the Charlotte region. "EMS transports them to CT, where the neuro team meets them."

No matter where patients go in the Novant Health system, care teams ensure patients receive timely, evidence-based stroke care. By combining speed, innovation and equitable access, the health system is setting the standard for comprehensive stroke care.