As Dearborn County Hospital in Lawrenceburg, Ind., prepares to mark its one-year anniversary with the UC Health Telestroke Network next Tuesday on the eve of Stroke Awareness Month, hospital President and CEO Roger Howard could not be more pleased with the initiative’s success.
“We have had just over 40 patients brought to our hospital who were candidates for the stroke protocol,” Mr. Howard said this week. “That’s 40 patients who may have been treated differently a few years ago. It is not a huge number, but one is a huge number if you’re the one. The program has changed 40 lives – 40 families — in this community.”
The UC Health Telestroke Network, an initiative that includes the Comprehensive Stroke Center at the UC Neuroscience Institute, enables physicians from the UC Stroke Team to “examine” stroke patients long-distance with the help of robots. UC Health launched the program in March 2012, with one robot placed in the UC Medical Center’s Emergency Department and another in the Neuroscience Intensive Care Unit. By early May 2013, UC Health will have seven official telestroke affiliates, including West Chester Hospital.
Opeolu Adeoye, MD, Director of the Telestroke Program at UC Health and Interim Director of the Division of Neurocritical Care, described the telestroke program as an outstanding success. “The introduction of telestroke genuinely adds a dimension that allows us to improve upon the care we have been delivering,” he said. “We hope this model in stroke serves to expand the services we are able to deliver to communities in the Greater Cincinnati region.”
Stroke is a leading cause of severe adult disability and the fourth leading cause of death in the United States. Time is precious when a stroke occurs, as brain cells lacking oxygen begin to die. People who have suffered an ischemic stroke — one caused by a blood clot — can reduce or eliminate their risk of death and disability through early treatment and the administration of the tPA within 3 to 4 ½-hours of the onset of the stroke’s first symptoms. At the same time, this drug does carry a risk: a small minority of patients will experience bleeding in the brain. A patient who avoids unnecessary administration of tPA therefore avoids that risk.
The telestroke robots can play a critical role in expediting evaluation and treatment of patients in hospitals in rural or outlying areas. The robots enable audio-video communications in real time between a patient and clinician at a distant site and a UC Stroke Team member (with laptop) wherever he or she is at the time. The Stroke Team physician can interview the patient and observe while the patient performs simple tasks, such as touching his or her nose or repeating words or phrases.
The physician also will be able to confirm or rule out facial droop and will even be able to see the size of the patient’s pupils. Ultimately, this co-evaluation by the community hospital’s emergency department and the Stroke Team specialists determines whether the patient should receive care at the outlying hospital or should be transferred to the UC Comprehensive Stroke Center for tertiary treatment.
Of the 40 stroke patients who were treated at Dearborn County Hospital in the first year of the telestroke program, 17 were transferred to the UC Medical Center.
At the opposite end of the treatment spectrum, telestroke can also help determine when less is best. Telestroke Program Manager Pam Kimmel, RN, BSN, noted that the very first telestroke patient would have received tPA based on the phone conversation shared between physicians. But after the Stroke Team physician examined the patient remotely, he determined that the stroke was not as severe as originally thought, and tPA – with its small but inherent risks — was therefore not administered.
Mr. Howard said that once the telestroke program was instituted at Dearborn County Hospital, the changes were almost instantaneous.
“The first huge change it made for us was to give our emergency room staff, physicians and nurses a tremendous amount of support,” he said. “When you are a rural or outlying hospital, you may not have that extra little bit of backup that can help reinforce your initial decisions.”
The extra support – a virtual second opinion – was also greatly appreciated by patients and their families, Mr. Howard said. “We have worked with the UC Medical Center for years, but the telestroke program really brought this to the forefront, and it let patients know they are in good hands. They can see the doctors online, can hear them participating in their care. It gives the families of our patients a very good feeling that there is a team of healthcare workers there to help them, and not just one solo physician, working on their behalf.”
Mr. Howard said the program had changed the public’s perception of the hospital, which supports 78 beds, 20,000 annual emergency room visits, and 150,000 annual out-patient visits. “The partnership with UC Health brings us up in stature as a place that can take care of you a little better when you come through our doors,” he said.
“Every other month I conduct a local town hall meeting at one of our outlying communities. During these meetings I talk to people about the hospital and healthcare in general. Approximately 75 to 100 people attend, so it’s a good way for Dearborn County Hospital to deliver new information and also find out what people are thinking.
“I bring up the topic of stroke and our affiliation with UC Health and the stroke protocol. The talks have enlightened the community and raised awareness about where people should go and – more importantly –when they should seek help. We have worked through our local EMS teams and city councils to communicate that if there is any sign of stroke, you or your loved one should come to the emergency room at once.”
UC Health committed funding to the launch of the telestroke program as part of its mission-based effort to bring world-class stroke care to hospitals beyond the 275 beltway and to underserved areas of the various surrounding states. In addition to Dearborn County, the project has been established at the following affiliate hospitals:
1. Adams County Medical Center, Winchester, Ohio
2. Clinton Memorial Hospital in Wilmington, Ohio
3. Dearborn County Hospital, Lawrenceburg, Ind.
4. Fort Hamilton Hospital, Hamilton, Ohio
5. Meadowview Regional Medical Center, Maysville, Ky. (as of May 2)
6. Southwest Regional Medical Center, Georgetown, Ohio
7. West Chester Hospital, West Chester, Ohio
— Cindy Starr