According to the National Stroke Association, stroke is the third leading cause of death in the U.S. resulting in $73.7 billion being spent on stroke related healthcare costs. During a stroke, 1.9 million irreplaceable brain cells are lost every minute—so time is of the essence. However, new developments in the telemedicine field have opened up opportunities for hospitals to save stroke patients brought to the hospital for treatment.
New telestroke programs are not only starting but also expanding. For example, C3O Telemedicine formerly C30 Medical Group is currently partnering with Community Memorial Health System in Ventura California. Both the medical group and health system are using telemedicine so stroke patients now have immediate connectivity to highly skilled neurologists and neurointensivists.
C3O Telemedicine offers not only telestroke care but also neurocritical care, telepsychiatry, critical care, and teleICU and other telemedicine solutions. The company has a new C3O website at http://c3otelemedicine.com/.
In 2010, to further telestroke services in rural areas, USDA’s Distance Learning and Telemedicine (DLT) program awarded a grant for $253, 260 to Providence Health & Services to add five rural critical access hospitals in Eastern and Central Oregon to the Providence Telestroke Network hub in Portland.
The funding was used to place mobile robot devices with human-like mobility in rural hospitals. Using two-way video cameras over a secure internet connection, Portland-based neurologists are now able to examine and talk to patients, family members, and clinicians.
Today, the Providence Telestroke Network connects stroke experts at the Providence St. Vincent Medical Center and Providence Portland Medical Center to 14 communities outside of Portland. Since 2010 the network has been able to evaluate more than 1,000 patients.
In another program reaching rural areas, Ochsner Medical Center the first hospital in Louisiana to use telemedicine is treating strokes in patients located in areas with smaller hospitals. In the last two and half years since being implemented, Oshsner is one of the fastest growing networks.
By utilizing Ochsner’s “Acute Stroke System for Emergent Regional Telestroke” (ASSERT), stroke neurologists are present virtually at a growing number of hospitals through secure wireless and video. Ochsner’s stroke team evaluates patients, directs care, and ensures that timely thrombolytic therapy is administered. With Ochsner Medical Center in New Orleans functioning as the hub, ASSERT links specially-trained vascular neurologists to spoke hospitals 24/7 for collaborative care.
There are several recent ongoing clinical trials studying the use of telemedicine when treating stroke patients. For example, A National Stroke Association clinical trial “Advancing Telestroke Care: Prospective Observational Study” is currently recruiting participants. Other sponsors of the trial include Mayo Clinic, Swedish Medical Center, Renown Regional Medical Center, University of Utah, and the California Pacific Medical Center.
The trial is underway at the University of Southern California in Los Angeles, and estimates enrolling 600 patients. The objective for the clinical trial is to see if telemedicine consultations used for acute stroke patients will improve their care and to see if stroke patients are also helped at hub hospitals. For more information, contact Gene Sung MD at gsung@usc.edu.
Another clinical trial “Telestroke in Nordland Hospitals: A Study of a Telemedicine Network” for an 18 month observation period is being conducted. The clinical trial sponsored by the University Hospital of North Norway will investigate the potential outcome for stroke patients in small rural hospitals using a telestroke service.
In Norway, providing telemedicine services can be vital especially in the Northern part of the country since there is a high turnover of clinicians, technical support is not available 24/7, severe weather conditions exist, and long distances can affect transportation efforts.
The study conducted at rural hospitals will examine patient flow by analyzing hospital information system data as well as monitoring teleconsultations. Hospital data on diagnosis, thrombolysis frequencies, and stroke complications like hemorrhage will be used to analyze the process.
The study will:
· Send videos and images using the RIS/PACS system
· Conduct semi-structured interviews and then follow-up with phone calls to hospital staff after telestroke incidents
· Observe patients and doctors during telestroke consultations
· Form semi-structured focus groups interviews to take place with health personnel involved with stroke patients
Email Bettina Heermann M.D., at Bettina.Heermann@nordlandssykethuset.no for more information.
