Competing South Carolina Hospitals Focus on Patients with Stroke Collaboration

Monday, July 17th, 2017

In many ways, Roper St. Francis and MUSC have all the makings of a classic rivalry. Both are large healthcare systems that offer a wide variety of services to Charleston residents on the peninsula and the surrounding areas, making them competitors in the exact same market. Plus, they are located less than 100 feet from each other, giving them a geographic intimacy which heightens the sense of competition.

In reality though, the two healthcare systems have the same goal of caring for patients, something which transcends the divide. For instance, the two have recently partnered on stroke treatment to bring down the care response time in ways that can be critical. The two hospitals had already been taking advantage of telemedicine tools to help diagnose stroke, but recently worked out an arrangement to have MUSC doctors come directly to Roper to performing a thrombectomy, a procedure to remove a clot, rather than transferring patients from one facility to another. 

“It's groundbreaking,” says Tabitha Nolen, MSN, RN, PCCN, Stroke Program Manager at Roper St. Francis. “Nobody's really done this before, not even in Europe. So it's a novel concept. The goal is to treat as many stroke patients as fast as we can in the community, no matter where they are.”

The idea was hatched between Erin Sparks, MD, a Roper neurohospitalist who got her training at MUSC, and Christine Holmstedt, DO, the medical director of MUSC Health’s Comprehensive Stroke Center and telestroke program, once the latter moved into her new position.

“There is always an opportunity to improve how we're providing care. One of the things we realized is that, being that we're about 100 feet apart, that the level of care really should be equal and even,” explains Holmstedt. “By collaborating and sharing physicians and resources, we've been able to level the playing field so that every patient that arrives at Roper St. Francis or MUSC gets that same level of care. A stroke neurology consult can happen extremely quickly, typically under five minutes for an evaluation. We also share resources with regard to neurovascular surgery and neuro interventional radiology, which are the providers of the thoracotomy for acute schematic stroke.”

The discussion for such a broad partnership began three years ago with the idea that the two institutions could simply be more effective if they shared resources.

“From the Roper standpoint, when I first got there, it was obvious that the administration was looking for direction, which way to go for neurosciences,” Sparks recalls. “MUSC is the leader in SC for stroke care, so we were really thrilled to join forces with them.”

Sparks and Holmstedt pitched the idea to their respective administrations and found a warm reception to the idea.

“It was ‘yes, this makes sense, and this is the way to make it happen,’” says Holmstedt. 

The motivation was clear—stroke is an incredibly prevalent disease in South Carolina, with more than 20,000 cases of the disease reported each year and an estimated treatment cost of $805 million annually. 

And, as Holmstedt points out, “it's very difficult and very expensive to build comprehensive, large stroke centers. They take a lot of resources, both financial and personnel.”

Rolling out the new process and program went incredibly smoothly, with five centers fully operational and 450 nurses trained in under 90 days. And since the program became fully operational in October of 2016, their average “door-to-needle” response time to stroke cases has dropped well below 60 minutes, which is considered the gold standard by the American Hospital Association. In one instance, a patient received treatment just 23 minutes after walking through the doors.

“Ultimately all the stroke patients in our community are getting the same care,” points out Nolen. She also notes that this isn’t the only case of collaboration—MUSC and Roper have also collaborated on rehab services and shared other resources where it made sense to avoid duplication and, above all, serve their patients.

“It's really comforting that when I get off at 5 p.m. from being on telestroke call, that I know a vascular-trained neurologist from MUSC is going to be covering at night,” concludes Sparks. “It's remarkably comforting.”