Improved team integration shaves 15 to 30 minutes off response time for stroke and aneurysm patients

by Shawn Oberrath

The brain is the command center for our lives. Keep the brain healthy, and the body can function, survive, even thrive. But deprive the brain of oxygen for just minutes, and everything goes awry.

When the large blood vessels in the brain are blocked, ischemic stroke follows, and time is of the essence to minimize damage and save lives. The clock starts ticking the moment an obstruction occurs, and it has been shown repeatedly that every minute saved before removing clots through mechanical thrombectomy helps improve patients’ functional recovery.

As health care systems and providers look for more ways to save time, Sami Al Kasab, M.D., an interventional neurologist at MUSC, discusses the use of the RapidAI app to prepare and alert neurological staff working on patients with ischemic stroke.

With AI integration of imaging suites at all MUSC hospitals and an app on all team members’ phones, communication happens rapidly and simultaneously. The AI app flags suspected large vessel blockages within 5 minutes after CT scanning. The app sends alerts and images to all connected team members, who can then examine the images and be prepared to spring into action.

“The premise for embracing AI technology is that can we use it to our advantage for faster imaging access and better communication among team members,” said Al Kasab.

With all team members connected to the app, they can stay updated instantly, bypassing older methods like phone trees and file sharing. Credit: Brennan Wesley

In the past, synchronizing the team – which includes neurologists, technologists, nurses, radiologists, endovascular surgeons and anesthesiologists – required cascading phone calls, in-person consultations, and repeat imaging for patients arriving from off-site. This process might take up to 30 minutes, but by connecting everyone involved immediately through the app, the team can make treatment decisions and be ready to move forward in less than 5 minutes.

Al Kasab also pointed to the great advantage of receiving advance notice for patients arriving from other locations. For example, with the app, team members will receive an alert that a patient at another remote hospital has a large vessel occlusion and is being transported to the hospital in Charleston for specialty care.

With this alert, on-call staff members can view patient scans prior to arrival and be ready to whisk them straight to the angiography suite for immediate treatment. And with the images already available, surgeons can proactively map out the best approach based on the patient’s anatomy and the location of the blockage while the patient is still en route.

“The possibilities are tremendous if we can reduce the average time from the patient’s arrival in the ED to the angiography suite from 60 minutes to 15 or 20 minutes,” said Al Kasab.

Indeed, for every 15 minutes saved in the crucial window from ED arrival to the start of thrombectomy, 40% of patients will be less disabled 3 months later.

Some health care systems that have transitioned to AI platforms have seen 20% increases in excellent outcomes for their stroke patients. Al Kasab and his team are collecting data on their response times and outcomes and hope to see similar or better results.

And while AI applications are not perfect, Al Kasab pointed out that CT images are always confirmed by human experts. AI saves time in most situations, but if there were a rare case of a missed call, radiologists would still be looking at patient images.

RapidAI has applications beyond stroke care as well. Alejandro Spiotta, M.D., the division director of neuroendovascular surgery and vice chair of the MUSC Department of Neurosurgery, is implementing it with his teams to find and interpret aneurysms.

“We’re not just accepting the current functionality of the AI system,” said Spiotta. “We’re looking ten steps down the road and finding new ways to help our patients.”

In the case of aneurysm, he explained that CT scans may show small clues that are easily missed during routine interpretation. Aneurysms are small bulges or bubbles of the arteries that can bleed, and when they do, half of patients don’t survive.

Spiotta is leveraging RapidAI as part of a statewide initiative to identify aneurysms more accurately and provide better preventive care to South Carolina patients.

By using the app, clinicians like Spiotta and Al Kasab can look at individual aneurysms and then pull up with patients virtually the next day to educate them on treatment and observation options. Some may require immediate treatment, but some may not.

Either way, these patients are integrated into the health care system and can be monitored throughout their lifetime, so if any problems arise they can be addressed immediately.

Both Spiotta and Al Kasab are using every technological advantage they can find to reach patients as quickly as possible. “We are really trying to save brain tissue,” said Spiotta. “We’re not just looking to be faster for the sake of being faster. The more brain we can save, the better off our patients will be.” 

Progressnotes Summer 2023