Neurologists at Temple Hospital are now able to provide health care for a stroke at select hospitals within a 100-mile radius through their REACH Health Telemedicine Stroke Program, which is possible after the implementation of an advanced telemedicine cart.
The REACH Access Telemedicine Cart connects TUH neurologists to distant “spoke” hospitals and enables them to conduct full neurology exams, medical decision-making and treatment by video conferencing.
“It’s sort of like a high-resolution Skype,” said Dr. Paul Katz, director of the TUH Stroke Program. “The resolution of the video is such that I could zoom in and actually look at their pupils and then zoom out and look at their whole body. With the help of a nurse or another doctor at the distant facility, I could do a full neurological exam on this particular patient.”
Each spoke hospital has a telemedicine cart in its emergency department. When an acute stroke patient is received at a spoke hospital’s emergency department, Temple’s Transport Team and Comprehensive Communication Center are alerted and on-call neurologists at TUH are located.
TUH is currently in a negotiation period to develop a network with spoke hospitals. Episcopal Hospital will be the first spoke hospital to participate in the stroke care program. The program will cover hospitals within a 100-mile radius of TUH.
This hub-spoke relationship between TUH and other hospitals offers an advanced level of medical care to stroke patients at spoke hospitals that may not otherwise have access to the necessary components for a stroke diagnosis.
“Temple is a certified stroke center,” Katz said. “There are hospitals in the community that either don’t have access to a neurologist or don’t have the capabilities of taking care of an acute stroke patient. If you’re three hours away by car, you’re never going to get to our hospital in time to receive treatment. By using telemedicine, I can assess them and decide whether they need treatment and can make recommendations.”
In addition, the system allows teams from both hospitals to access one another’s medical and laboratory records as well as radiology imaging procedures like MRIs, CT scans and X-rays for further assessment and treatment.
The purpose of the program is to improve a major health issue in the United States. Strokes are the fourth leading cause of death in the U.S., according to the Center for Disease Control and Prevention, and one American dies from a stroke every four minutes on average. The CDC also reports strokes as a leading cause of adult long-term disability.
“The goal is to try to make sure that the patient doesn’t have any residual impairments as a result of having a stroke and to make sure they can return to normal life activities,” said Rosemary Nolan, chief operating officer at TUH.
The program includes a multidisciplinary team, standard stroke protocols, physician recommendations, patient charting and an automated “door-to-needle” timer that can play a vital role in a time-sensitive situation. Thus, it reduces the possibility of a long-term disability.
“Part of the system is an automated timer that monitors the amount of time that’s elapsing from the time they call until the time we’re able to provide the orders for t-PA administration,” Nolan said.
T-PA, a new and advanced “clot-busting” medication for strokes, is recommended to be administered to patients immediately after stroke symptoms appear.
This medication dissolves any blood clots that could cause a stroke. The “door-to-needle” timer is important because it gives the neurologists the amount of time doctors have left to assess the patient and decide if t-PA can and will be administered.
“The sooner they can administer the medications, the better the outcome for the patient,” Nolan said.
Once exams, diagnostics and treatment are in progress at the spoke hospital, the case is further assessed to determine whether the patient needs additional medical care at TUH. If necessary, TUH will make arrangements for the patient’s transfer.
“Telemedicine is a vital part of any comprehensive stroke effort,“ Katz said. “I ran a very large rural stroke network in the state of Nevada. … I can’t tell you the difference it makes for people who live in areas in which that don’t have access to tertiary medical care. Temple University is very community-oriented and this really fits along with that mission.”
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