New Telestroke program at Covenant could be a life-saver
by Augusta Sires
When it comes to treating stroke, every minute is critical. To make the most of every one of those minutes, stroke patients at Covenant Medical Center now have access to immediate remote diagnosis by neurologists at the University of Iowa Hospitals and Clinics.
Beginning this month, University of Iowa Stroke Center neurologists will examine Covenant Emergency Department stroke patients in real time by using a “robot” that features a video screen for teleconferencing, pan-tilt-zoom camera, and stethoscope.
“We’ll be in contact with world-class neurologists within minutes of seeing the patients,” says Todd Lawrence, MD, Covenant’s Emergency Department medical director. “It increases our ability to make higher-level decisions about treatment and transfer. It will save lives and improve outcomes by giving advanced care sooner.”
Covenant will be the fourth Iowa hospital in the Telestroke program using a mobile InTouch Health Xpress robot.
“In a rural state like Iowa we recognized a need to bring specialized emergent time-sensitive resources to patients in their own community,” says Enrique Leira, MD, a neurologist with UI Health Care. “The certified UI Comprehensive Stroke Center implemented Telestroke to provide expert stroke care locally. Telestroke allows our neurologists to perform a real-time evaluation of the patient and discuss treatment options with the patient, family, and health care team at Covenant.”
Strokes are the third leading cause of death nationally, according to the Centers for Disease Control, claiming 140,000 lives annually. In addition, an estimated 795,000 people suffer a stroke each year, making it the leading cause of long-term disability. The U.S. has only four neurologists for every 100,000 people.
Studies done for the National Institutes of Health have found that stroke symptoms can be misleading to patients and family members, as well as misdiagnosed by physicians when it is essential to get it right quickly and accurately to save lives and enhance recovery.
Lawrence says a stroke alert is issued when a patient arrives in the Emergency Department with an apparent stroke, generating a response that includes doing a CT scan to locate the possible clot.
“If a patient has stroke-like symptoms, we’ll contact University of Iowa immediately,” he says. “A stroke specialist there has a laptop on them at all times. When they open it up, their face will be on the robot. They will discuss the case with the physician, then see and talk with the patient and family. Then they can render advice based on the symptoms.”
“Sometimes communication is so difficult over the phone that it’s hard to appreciate the severity of the patient until you lay eyes upon them,” Lawrence adds.
The decision is then made to either transfer the patient to UI Hospitals and Clinics for advanced care or have them stay at Covenant. If they do not meet certain criteria or need for advanced stroke care, the University of Iowa will give that feedback and the patient can stay locally.
An estimated 87 percent of strokes are “ischemic,” caused by a clot blocking blood flow to a particular region of the brain and treated by rt-PA (tissue plasminogen activator), which dissolves the clots and restores the blood flow when brain cells are dying with every passing minute.
“The key is identifying who is a candidate for rt-PA and intervention and who isn’t. The advanced stroke team at University of Iowa makes that decision,” Lawrence says.
“If the stroke is ischemic and the patient meets certain criteria, then we can use rt-PA to help reverse the clot,” he adds. “The other thing that can be done is intervention. Neurologists who are interventional can go in and inject rt-PA directly into the clot or they can do more advanced procedures than we can do at Covenant.”
The other 13 percent of strokes are “hemorrhagic,” when blood vessels in the brain rupture and the blood accumulates in the surrounding brain tissue, which is “managed completely differently,” Lawrence says.
“With some strokes there’s not much more you can do, other than supportive treatment, and other types need immediate intervention,” he adds.
Another advantage of Telestroke is avoiding unnecessary transfers.
“We are looking forward to advancing our stroke care by bringing treatment to patients with stroke symptoms earlier and, when appropriate, keeping these patients in the community to be closer to their homes and their families,” says Carol Ratchford, RN, Covenant’s Emergency Department manager.