When it comes to treating victims of stroke or other neurological emergencies, time is crucial. For that reason, Newton Medical Center recently launched a new telestroke program – using telemedicine videoconferencing technology – to enhance its ability to better connect patients with neurologists.
As a result, those neurologists will be able to quickly diagnose and treat patients any time of the day.
“The best outcomes occur when stroke treatment is administered within 90 minutes of symptom onset,” said Colin Windham, MD, medical director of emergency services at Newton Medical Center. “FAST is an easy way to remember and identify the most common stroke symptoms, which affect a person’s face, arms and speech. Because ‘time is brain,’ anyone who observes these signs should call 911 immediately.”
The acronym FAST is an easy way of recognizing the symptoms of a stoke – to remember to notice if one side of a person's face (F) is drooping, if they cannot lift one of their arms (A), whether they cannot repeat a phrase or their speech (S) is slurred and to act, by calling 911, in a timely (T) matter.
“When a patient comes to our Emergency Department with a neurologic complaint, our ED (Emergency Department) physicians must act quickly. They must decide if that complaint is indeed a stroke and whether it is the type of stroke that needs surgical intervention at a specialized stroke center,” said Val Gleason, president and chief executive officer of Newton Medical Center. “With our new 24-hour telestroke program, we now have stroke experts who can help us decide precisely which patients need that specialized treatment outside our community.”
In summer 2016, NMC launched a telemedicine program focusing on general inpatient care. That program already allows telemedicine physicians practicing in other Kansas locations to admit ED patients to the hospital quickly. Those physicians also provide diagnosis and treatment in the middle of the night.
That program has been a success, so NMC investigated other ways telemedicine could benefit patients and physicians. The teleneurology program offered by Eagle Telemedicine, an Atlanta-based firm that provides NMC’s general telemedicine program, seemed like a natural fit.
Best-in-class teleneurologists on the Eagle team are achieving impressive results: an average response time of 3.5 minutes, and an average diagnosis and treatment time of 21.8 minutes.
“As our nation’s older population grows, the frequency of strokes and other acute neurological problems is increasing, too,” Gleason said. “Yet the supply of neurologists is dwindling —not good news for hospitals like NMC. Given this scenario, teleneurology is a perfect evolution for telemedicine. It enables us to provide best-in-class neurological care to our patients today, and positions us to answer increasing needs for that care in the future.”
In addition to diagnosing and treating patients, teleneurologists can also provide effective follow-up care for the remainder of a patient's stay, consulting with patients and providing ongoing support and advice to the local clinical team via two-way videoconferencing.
According to Newton Fire/EMS Chief Scott Metzler, the department takes 20 to 30 stroke patients to Wichita each year. Those patients might have previously been able to receive treatment at NMC, if a neurological specialist had been immediately available.
Director of marketing for Newton Medical Center Leslie Helmer said, since the official launch of program (Jan. 18), NMC has been able to diagnose and treat nearly 20 patients who otherwise may have been transferred to another hospital in Wichita.
If a patient arrives at the hospital with stroke symptoms, Helmer said NMC's Stroke Response Team is immediately notified through a protocol the hospital has in place. This interdisciplinary team is made up of doctors, nurses and other medical professionals from NMC's ED, Critical Care Unit (CCU), Lab, Imaging department and Respiratory Therapy department.
Breaking down the telestroke care process, Helmer said the ED physician does an initial assessment of the patient and then notifies a tele neurologist – an expert in neurological care. NMC’s new telestroke program provides access to this type of expert 24/7.
"Within minutes, often just seconds," Helmer said, "the ED physician is on the phone with the teleneurologist, giving a summary of his or her assessment. During this time, the Stroke Response Team ensures the patient gets a CT scan and then gets labs drawn – all within 20 minutes of arrival."
After that, Helmer said the teleneurologist does an evaluation of the patient via a robot, while answering questions from the patient or family members. This tele-videoconferencing technology allows NMC to connect with expert physicians who work off-site.
Within the next 25 minutes, Helmer said the teleneurologist reviews and interprets the scan and lab work in order to make a recommendation to the ED physician, which may include administering a clot-dissolving drug called Alteplase. These precise coordinated efforts ensure stroke patients are diagnosed and treated within 90 minutes of arrival.
"Our teleneurologists also provide follow-up care for those patients we admit," Helmer said, "and in the rare case that a stroke patient needs a surgical intervention at a specialized stroke center, our new teleneurology program helps us identify exactly who those patients are."
Current, local EMS protocol dictates that possible stroke patients who meet a certain threshold are taken to Wichita hospitals. While this protocol which requires local EMS providers to often bypass NMC is still in place, NMC expects that to change as a result of the new teleneurology program.
“Our goal is to keep more patients in their home community when they need healthcare,” Gleason said. “It’s good for them. It’s good for their families. We are proud to be able to offer this new specialty to the community.”
A team of six certified neurology specialists make up Newton Medical Center’s teleneurology team. They are Dr. Chad Miller, vice president of neuroscience and director of neurocritical care, Riverside Methodist Hospital, Columbus, Ohio, Dr. Ira Chang, Director of Acute Care Neurology at Swedish Hospital in Denver, Colorado and the Colorado Neurological Institute, Dr. Kevin Sheth, director of neurocritical care at Yale University in New Haven, Connecticut, Dr. Shilpa Tilwalli, former assistant professor at Rush University in Chicago, who is now practicing in Palo Alto, California, Dr. Natasha Renda, assistant professor of neurology at the University of Southern California in Los Angeles and Dr. Jeff Wagner, director of St. Joseph’s Medical Center Stroke Program in Denver, Colorado.