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Rural North Carolina Gets Savvy With Teleneurology For Stroke

Cheryl Clark, for HealthLeaders Media, October 28, 2009

Womeldorf adds that his community needs better stroke care because of the high number of people with COPD, cardiac problems, high blood pressure and obesity, all conditions that accompany a much higher risk of stroke.

Each of the hospitals will pay about $100,000 a year for the Specialists On Call service, Forsyth officials say, but they will more than make up for it with business they receive in additional stroke patients.

Besides, providing better care is just the right thing to do, they say.

Robin Voss, a registered nurse and vice president of neurosciences and orthopedics at Forsyth, says that in the stroke belt, "stroke death rates are two times greater than the rest of the nation.

But most of the smaller facilities "don't have a neurointerventional radiologist who is on call 24/7. This ability to video conference in with these specialists will allow these patients a chance for a better outcome," Voss says.

"If you look in the literature, only about 3% of all the patients who could benefit from tPA get tPA," says Voss. "And if we could just increase that number by 1%, millions of dollars now spent on disability in this country would be saved."

But getting the expertise on board is just the start of the process. Residents will have to be educated not to just take an aspirin and go to sleep when they get a symptomatic "really bad headache."

They will have to be told about the importance of calling 911 instead of attempting to drive or be driven to a hospital for care.

And there will have to be training and monitoring by intensivists after the tPA is given in the rural setting.

For some patients, remote observation in a facility near their homes will enable distant neurologists to determine if the patients might be eligible for other kinds of stroke care, especially if they have exceeded the three-hour window.

At Hugh Chatham, Womeldorf says he has his work cut out to start educating community residents about the new service. He's going to churches, the media, health fairs, and there will be advertising to alert people to the new local stroke service.

And he will do his best to convince them not to even think about driving to the hospital if they think they're having a stroke – even if they're worried about what the neighbors will say when the ambulance pulls up.


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Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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