Stroke Care Benefiting from Telemedicine AdvancesStroke is a serious medical problem that takes its toll in the United States, killing nearly 130,000 Americans every year.
One out of every 19 deaths in the US is due to stroke, and on average, an American dies of stroke every four minutes. Each year in the US, more than 795,000 people will experience a stroke, and most of these are first strokes. The majority of strokes are known as ischemic strokes, in which blood flow to the brain is blocked.
Stroke is expensive too, costing an estimated $36.5 billion per year including the cost of healthcare, medications, and missed work. A leading cause of serious, long-term disability, stroke requires prompt care for the best outcomes. Fortunately, telemedicine is allowing more people to get quicker stroke treatment, improving outcomes, saving time, and saving resources. Following are several promising examples of telemedicine stroke care in the US and elsewhere in the world.
Telemedicine Care for Stroke Patients in Lee County, Florida
In Lee County, Florida, off-site neurologists can now evaluate emergency patients that come in with stroke symptoms, offering remote consultations via video conferencing equipment. When a person with suspected stroke arrives in the ER, he or she will undergo a CT scan. While the scan is taking place, the ER physician contacts the neurologist on call and presents a brief overview of the patient’s condition. Meanwhile, technicians set up a tele-health cart in the patient’s room.
The ER staff, with the use of high quality interactive video conferencing technology, work with the neurologist on call who is able to provide an evaluation and if necessary order the administration of clot-busting drugs, which can reduce disability and death when given in a timely manner. Neurologists can review CT scan results remotely and lead the ER care team through specific protocols in real time so stroke patients are treated appropriately with minimal delay.
Stroke Care at Temple University
Temple University in Pennsylvania has implemented a “hub and spoke” hospital system that allows neurologists to deliver care to patients in more remote hospitals via telemedicine. At the hub hospital, the stroke team physicians use live video and electronically-delivered lab and CT scan results to see and evaluate patients in spoke hospitals. Because these consults are done quickly, in real time, more patients can get life-saving medications like clot-busting drugs without delay.
With Temple University Hospital as the hub hospital, the first spoke site is Episcopal Hospital, which will be able to make quicker decisions regarding diagnosis and treatment of stroke. Because time is so critical in stroke cases, the new system includes a “door to needle” timer that tracks time during the remote consultations and offers standard stroke protocols and best-practice recommendations in an effort to improve patient outcomes.
Rural Germans Access Telemedicine for Stroke
Telemedicine is improving care access for stroke patients in rural Germany, according to a study published in 2014 in the journal Stroke. Doctors from Krankenhaus Agatharied in Hausham, Germany analyzed data to assess processes and outcomes of stroke patients based on hospital reports. Participants in the study were treated in hospitals participating in the Telemedical Project for Integrative Stroke Care program. The researchers analysed nearly 55,000 cases of stroke that took place between 2003 and 2012 in 15 regional hospitals. Of these, nearly 32,000 telemedicine consultations were performed. In 3,331 cases of stroke, clot-busting drugs were given, and there was a median decrease in onset-to-treatment times from 150 minutes to 120 minutes, and a “door to needle” time decrease from 80 to 40 minutes. In other words, these rural patients in Germany received stroke care much faster than they would have without telemedicine.
In-Home Stroke Care in Oregon via Telemedicine
Stroke patients in parts of Oregon can now receive follow-up care from their homes using telemedicine. In states with large rural areas like Oregon, medical specialists tend to concentrate in larger cities, making it more of a burden for rural patients to attend follow-up appointments. The Oregon Health and Science University Telemedicine Network now allows secure, two-way video conferencing both for treating strokes in emergency departments, and for delivering follow-up care in patients’ homes and local clinics.
Follow-up care, including management of factors like high blood pressure, is critical to reducing the chances of patients suffering subsequent strokes. But some patients are simply not able to return long distances for follow-up care. Telemedicine is allowing patients to receive follow-up care regardless of where they live, greatly increasing convenience and compliance with follow-up care recommendations.
Stroke Telemedicine Services in the Rocky Mountains
The Swedish Medical Center system that operates in parts of Colorado, Kansas, and Wyoming has started using telemedicine to allow neurology consultations for patients in emergency departments. Using laptop computers and secure video conferencing, neurologists can examine patients remotely, and even see, via video, subtle signs like changes in eye movement that are important in diagnosis and treatment of stroke. Neurologists can receive patient vital signs and speak in real time with the patient, family members, and emergency staff. Neurologist Christopher Fanale says, “This technology makes it so I’m almost literally in the room next to the patient. I can now ‘be’ at a hospital 100 miles away in a matter of minutes – overcoming the hurdles of time and distance that can mean life or death for some people.”
With stroke, the difference of a few minutes can mean the difference between life and death. Telemedicine allows emergency department staff and neurologists to save precious minutes and deliver treatment to stroke patients much more quickly, reducing the chances of death or catastrophic disability. And some neurologists are providing follow-up care to stroke patients via telemedicine, improving convenience for rural patients, and increasing compliance with post-stroke care recommendations.
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