Improving stroke care virtually

October 19, 2011

The telestroke cart

When stroke symptoms occur, every second counts. A new Mercy telemedicine program could help improve time to treatment, possibly saving the lives of local stroke patients. The program is called Telestroke.

Telestroke is a time-saving system designed to get stroke patients in front of a board-certified neurologist faster than ever before. When patients arrive at the hospital with stroke-like symptoms, care professionals can get an immediate video consultation with a neurologist. The importance in getting an evaluation so quickly is to determine stroke therapy.

A patient is only a candidate for t-PA (tissue plasminogen activator) or intra-arterial therapy within three hours of the onset of symptoms. Both of these therapies can lessen, or even reverse the damage caused during a stroke.

“A complicating factor is that not all hospitals have these therapies available, so it’s crucial to determine what’s needed as quickly as possible, then refer the patient to the appropriate level of care at an appropriate level of facility,” explains Eddie Spain, administrative director for Mercy Neurosciences. He foresees the capabilities of Telestroke expanding to Mercy’s smaller, rural hospitals and helping to improve the process for all stroke patients because it’s such a time-critical diagnosis.

Mercy Stroke Center was one of the first hospitals in the nation to receive The Joint Commission’s Certificate of Distinction for Primary Stroke Centers in 2004. Since that time, the center helped hospitals throughout the region start their stroke programs. Mercy receives patients from the surrounding community hospitals in a 34-county area in Missouri and Arkansas. Collaboration and a streamlined process for identifying a stroke and determining a treatment plan are crucial.

Stroke Coordinator Carol Beal, RN, explained that improving time to treatment requires a commitment to making sure all stroke patients receive the care set by national stroke benchmarks – benchmarks Mercy Stroke Center helped to create in 2002. Those benchmarks include coordination efforts such as team activation and quick-moving processes.

Telestroke makes it possible to determine course of treatment within 15 minutes. During this time, the patient is sent for a CT scan (X-ray computer tomography) and blood is drawn for lab tests. A video cart system is wheeled into the patient’s room and the physician appears on the video monitor within minutes. The physician evaluates the patient with the assistance of a doctor or nurse.

The data’s clear that this kind of physical exam is equivalent to a bedside evaluation by a physician. You get this service provided within 15 minutes of a phone call. That’s something most places can’t get,” said Dr. Chris Veremakis, medical director at the Mercy Center for Innovative Care (CIC) in St. Louis.

The CIC is sponsoring programs like Telestroke and furthering the capabilities of telemedicine across Mercy’s four-state service area.

Telestroke utilizes a high-resolution camera system, powerful enough that the physician can check for symptoms such as pupil dilation by zooming in as the nurse holds the eyelid open. The physician can speak directly to the patient, family members, doctors and nurses. The physician can also enter notes and orders in the electronic health record.

Physicians doing the video consultation are from NeuroCall, a Miami-based provider of emergency neurological coverage. The NeuroCall physicians assigned are board-certified in Missouri and Arkansas and credentialed at Mercy hospitals, including Mercy Hospital in Springfield and St. Joseph’s Mercy in Hot Springs.

“Telestroke gives our emergency room physicians real-time access to a board-certified neurologist at all times of the day or night,” said Spain. The NeuroCall neurologists also have had training in Mercy’s electronic health record. They have the ability to immediately view all of the patient’s pertinent laboratory results, X-ray results, and past medical history just as if they were standing at the patient’s bedside.”

Beal reminds people of the importance of recognizing their own symptoms and calling for help as soon as possible. “People experiencing these symptoms should call 9-1-1 immediately. The longer a person’s brain is denied oxygen and glucose as a result of a blood clot or other blockage, there is a greater chance that the patient will not fully recover,” she said.

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