Latest / Becker’s Healthcare Podcast / Nicolle W. Davis and Janice Walker of UF Health on Innovation and Specialized Stroke Care

Transcript

Nicolle W. Davis and Janice Walker of UF Health on Innovation and Specialized Stroke Care · Becker’s Healthcare Podcast

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• 1:00
  - Welcome to the Becker's healthcare cardiology and heart
• 1:04
  - surgery podcast. I'm Mariah Taylor, assistant editor, and
• 1:07
  - I'm thrilled to be speaking with two leaders
• 1:09
  - from the University of Florida Health. First, we
• 1:11
  - have doctor Nicole Davis, director of the mobile
• 1:14
  - stroke program and mobile stroke treatment unit.
• 1:17
  - And we have Doctor. Janice Walker, system nursing
• 1:20
  - officer and senior vice president.
• 1:22
  - Thank you both for joining me today. I'm
• 1:24
  - really excited to learn more about all of
• 1:26
  - your work in mobile stroke care. But before
• 1:29
  - we dive into that, I'd love for you
• 1:30
  - to introduce yourselves and tell us a little
• 1:32
  - bit about your background. Doctor Walker?
• 1:35
  - Well, thank you for having us today. We're
• 1:37
  - so honored to to highlight our work around
• 1:40
  - our mobile stroke unit. So I'm doctor Janice
• 1:42
  - Walker. I'm the system chief nursing officer
• 1:45
  - of University of Florida Health Enterprise,
• 1:47
  - and I've been here, since January 19,
• 1:51
  - so just a short period of time. But
• 1:54
  - one of the things I did after I,
• 1:56
  - arrived is I can't
• 1:58
  - lead you if I don't know you. And
• 2:01
  - so,
• 2:02
  - the first 90,
• 2:04
  - I really, really did a lot of rounding,
• 2:07
  - in all of my hospitals, all of my,
• 2:10
  - ambulatory areas where care is provided.
• 2:12
  - And one of the things I strum stumbled
• 2:15
  - upon
• 2:16
  - was the University of Florida Health mobile stroke
• 2:18
  - team
• 2:19
  - unit, of which I'd never had in my
• 2:22
  - career
• 2:23
  - in other large health care systems where I've
• 2:26
  - served as assistant chief nurse.
• 2:28
  - So I cleaned off my calendar one day
• 2:31
  - and and reached out to to doctor Nicole
• 2:33
  - and said, I'm putting on scrubs, and I'm
• 2:36
  - coming to watch. I'm passionate about stroke care.
• 2:39
  - I've always led,
• 2:41
  - stroke organizations
• 2:43
  - to accreditation
• 2:44
  - and,
• 2:46
  - very sensitive to the the time frames of
• 2:49
  - that stroke progressing.
• 2:51
  - So when I saw what I saw on
• 2:53
  - the streets
• 2:54
  - of Gainesville
• 2:55
  - related to this struggle,
• 2:58
  - team and the struggle and the mobile stroke
• 3:01
  - unit,
• 3:01
  - I was blown away with the quick
• 3:05
  - diagnostic
• 3:07
  - as well as interventions
• 3:08
  - that happen
• 3:10
  - before hospital arrival.
• 3:12
  - So I said to many of my colleagues
• 3:14
  - across the nation,
• 3:16
  - wow. You're not gonna believe what the University
• 3:18
  - of Florida is doing
• 3:20
  - in the community
• 3:21
  - prehospitalization
• 3:22
  - related to stroke care.
• 3:26
  - Yes. I echo doctor Walker's sentiments. Thank you
• 3:29
  - so much for having us. My name is
• 3:31
  - Nicole Davis. I am the system director of
• 3:33
  - the mobile stroke program here at UF Health.
• 3:36
  - A little bit of my background is I
• 3:37
  - am a nurse by trade and have done
• 3:39
  - my entire training in neuroscience nursing. And right
• 3:43
  - here at the University of Florida, we have
• 3:45
  - one of the best neuroscience programs in the
• 3:47
  - country, so I've been honored to be a
• 3:48
  - part of this program for eighteen years.
• 3:52
  - Excellent.
• 3:53
  - Now
• 3:54
  - doctor Walker, I think, gave us such a
• 3:56
  - great overview of what this program is and
• 3:59
  - kind of what it's doing. But, doctor Davis,
• 4:01
  - can you give us a little bit more
• 4:03
  - detail about your stroke care EMS ambulances?
• 4:06
  - Absolutely. The UF Health mobile stroke treatment unit
• 4:09
  - is a specialty equipped ambulance designed to bring
• 4:11
  - advanced stroke care directly to patients in the
• 4:13
  - field.
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  - So each unit is outfitted with a portable
• 4:16
  - CT scanner, telemedicine technology,
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  - stroke specific medications, and expert clinical crew capable
• 4:22
  - of beginning stroke evaluation and treatment before arrival
• 4:25
  - at a hospital.
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  - The MSTU is fully integrated into each county's
• 4:29
  - 911 dispatching system,
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  - meaning community members just simply call 911 as
• 4:34
  - they normally would during a suspected stroke emergency.
• 4:37
  - The MSTU responds alongside traditional EMS resources,
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  - and once on scene, the MSTU stroke trained
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  - registered nurse and critical care paramedic will evaluate
• 4:46
  - the patient for signs of some signs and
• 4:48
  - symptoms of stroke. If a stroke is suspected,
• 4:50
  - the patient is brought onto the unit where
• 4:53
  - the crew can immediately begin the stroke workup
• 4:55
  - right on scene. That workup includes
• 4:58
  - imaging, CT,
• 4:59
  - laboratory testing, neurological assessment, and consultation with a
• 5:03
  - board certified vascular neurologist
• 5:05
  - through telemedicine.
• 5:06
  - UF Health is currently the only health system
• 5:09
  - in Florida operating a mobile stroke treatment unit.
• 5:12
  - The first was launched in Gainesville in July
• 5:14
  - 2023, followed by a second unit in Jacksonville
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  - in June 2025, and a third serving The
• 5:20
  - Villages in July 2025.
• 5:23
  - Each MSTU operates in close collaboration with a
• 5:26
  - local
• 5:27
  - EMS agency. So in Gainesville, we collaborate with
• 5:30
  - Alachua County Fire Rescue.
• 5:32
  - In Jacksonville, it's Jacksonville Fire and Rescue Department.
• 5:34
  - And in The Villages, it's The Villages Public
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  - Safety Department.
• 5:38
  - Each MSTU is staffed by a multidisciplinary
• 5:41
  - team that includes a stroke trained registered nurse,
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  - CT technologist,
• 5:45
  - paramedic, and or EMT operator, while also, again,
• 5:49
  - connecting to a stroke trained neurologist.
• 5:52
  - Incredible. I I mean, this is such an
• 5:54
  - interesting program, and I'm so surprised that you've
• 5:57
  - been running this for three years, and we
• 5:59
  - haven't heard about it here at Becker's. So
• 6:01
  - I'm sorry. We're a little late to this
• 6:02
  - game, but I am just so interested to
• 6:05
  - know what was the most difficult part of
• 6:08
  - getting this off the ground, and what were
• 6:10
  - some of those initial barriers you had to
• 6:11
  - overcome?
• 6:12
  - It truly was a labor of love to
• 6:14
  - get the mobile stroke treatment unit program off
• 6:16
  - the ground. Mobile stroke is still relatively new
• 6:18
  - within the stroke system of care, and the
• 6:20
  - UF Health team spent significant time learning from
• 6:23
  - established programs across the country. We visited several
• 6:26
  - mobile stroke programs, rode along on their units,
• 6:28
  - learned firsthand from their experiences, and we remain
• 6:31
  - incredibly grateful to those programs for opening their
• 6:33
  - doors and sharing their knowledge with us as
• 6:35
  - we built our very own program.
• 6:38
  - But one of the largest initial barriers to
• 6:40
  - launching the program was funding. Mobile Stroke is
• 6:43
  - resource intensive and currently
• 6:45
  - is not yet formally recognized as a service
• 6:47
  - line by CMS. So as a result, the
• 6:49
  - limited billing opportunities
• 6:51
  - available for these units do not cover operational
• 6:54
  - costs required to sustain the program.
• 6:56
  - Despite these challenges, UF Health recognized the value
• 6:59
  - of bringing expert stroke care directly to patients
• 7:01
  - in the field to help decrease death and
• 7:04
  - disability from stroke.
• 7:05
  - Stroke remains a fifth leading cause of death
• 7:08
  - both nationally and in Florida, but more importantly
• 7:11
  - as a leading cause of long term disability
• 7:13
  - for adults.
• 7:14
  - The ability to diagnose and begin treatment earlier
• 7:16
  - can dramatically improve patient outcomes and the MST
• 7:19
  - was developed with that goal in mind.
• 7:22
  - Another major challenge was EMS buy in. The
• 7:24
  - concept of an ambulance delivering hospital level stroke
• 7:27
  - care in the field
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  - represented a significant paradigm shift within emergency medicine.
• 7:32
  - Traditionally, EMS providers are trained to rapidly transport
• 7:36
  - suspected stroke patients to the hospital as quickly
• 7:38
  - as possible to access that care. But with
• 7:41
  - the MSU, we're able to bring the hospital
• 7:43
  - directly to the patient to perform that imaging,
• 7:45
  - initiate stroke evaluation, and treatment right on scene.
• 7:49
  - While this approach required a shift in traditional
• 7:51
  - thinking, our EMS partners have quickly recognized the
• 7:54
  - value of reducing the time to treatment and
• 7:56
  - improving outcomes for stroke patients in the communities
• 7:58
  - that we serve.
• 8:01
  - Excellent. And I'm sure in the last three
• 8:03
  - years, you've seen some incredible results. So tell
• 8:05
  - us a little bit more about that.
• 8:07
  - Yeah. So nationally, only about ten percent of
• 8:10
  - stroke patients are receiving care in that clot
• 8:12
  - busting medicine within ninety minutes of symptom onset.
• 8:15
  - And even less, less than two percent nationally
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  - are treated within that critical
• 8:20
  - first sixty minutes, which we call the golden
• 8:22
  - hour. That's important because early treatment significantly reduces
• 8:25
  - the chance of long term disability and death
• 8:27
  - from stroke.
• 8:29
  - By having a mobile stroke treatment unit, UF
• 8:31
  - Health is able to change those outcomes. We
• 8:34
  - are able to perform that stroke evaluation, initiate
• 8:36
  - treatment in the field, and with that approximately
• 8:39
  - sixty two percent of mobile stroke patients are
• 8:41
  - treated within ninety minutes of stroke symptom onset
• 8:44
  - and thirty four percent are treated within that
• 8:46
  - golden hour.
• 8:47
  - In in addition to increasing the number of
• 8:49
  - patients treated quickly,
• 8:51
  - the MSU also
• 8:53
  - dramatically reduces the time to treatment. So on
• 8:56
  - average, patients cared for on the mobile stroke
• 8:58
  - treatment unit receive thrombolytics or that clot busting
• 9:01
  - medication about one hour sooner than patients transported
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  - through traditional EMS pathways
• 9:06
  - to the hospital. That time savings translates directly
• 9:10
  - into better patient outcomes.
• 9:11
  - So patients treated on the mobile stroke treatment
• 9:13
  - unit experience a thirty percent increase
• 9:17
  - in likelihood of being directly discharged to home,
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  - a shorter hospital length of stay by an
• 9:23
  - average of two days, and a decrease in
• 9:25
  - mortality by forty five percent.
• 9:28
  - These outcomes really reinforce the importance of rapid
• 9:30
  - stroke treatment and demonstrate how delivering specialized stroke
• 9:33
  - care directly in the field can make a
• 9:35
  - meaningful difference for our patients and families across
• 9:38
  - the communities that we serve.
• 9:41
  - That's absolutely
• 9:42
  - incredible
• 9:43
  - results. No wonder you've been expanding this program
• 9:46
  - and I'm sure you have a lot more
• 9:48
  - planned. So what does the future look like?
• 9:51
  - Yeah. The future is really exciting for UF
• 9:53
  - Health Mobile Stroke. So as a program, we
• 9:55
  - want to continue to demonstrate improved patient outcomes,
• 9:58
  - reduced disability, and faster access to life saving
• 10:01
  - stroke care. Equally important is continuing to educate
• 10:04
  - communities about stroke recognition and the importance of
• 10:07
  - calling 911 immediately
• 10:08
  - at the first sign of symptoms.
• 10:10
  - Even the most advanced stroke systems rely on
• 10:13
  - rapid activation
• 10:14
  - by patients, families, or even bystanders.
• 10:16
  - So we want to combine public education with
• 10:18
  - advanced prehospital stroke care, creating the greatest opportunity
• 10:22
  - to reduce disability and saves lives.
• 10:25
  - Ultimately, the vision of the UF Health Mobile
• 10:27
  - Stroke Program is simple. We want to ensure
• 10:29
  - stroke patients receive care as quickly as possible.
• 10:32
  - Every minute saved during a stroke can preserve
• 10:35
  - brain function, independence, and quality of life. And
• 10:37
  - mobile stroke can help redefine what is possible
• 10:40
  - in emergency stroke treatment.
• 10:43
  - Amazing.
• 10:44
  - Well, thank you both for joining me today
• 10:47
  - on the podcast. This has been such a
• 10:48
  - cool program to dive into, and we just
• 10:51
  - appreciate you sharing all your results.
• 10:54
  - Thank you for having us. It was,
• 10:56
  - a day I'll never forget when I watched
• 10:58
  - the interdisciplinary
• 11:00
  - team
• 11:01
  - in the back of that truck quickly assess,
• 11:04
  - diagnose,
• 11:05
  - and treat in the field
• 11:07
  - before the patient ever arrived in the emergency
• 11:10
  - room.