Telestroke Programs Link Stroke Specialists to Patients Unable to Access Care

Cynthia Johnson, October 30, 2009

On April 6, Michael Harrigan, 58, was driving 70 mph on Interstate 94 from Milwaukee to a business meeting in Madison, WI. He never did make it to his meeting, because he suffered a stroke halfway there. The series of events that occurred following his stroke are nothing short of miraculous.

Harrigan was able to pull over his car and call 9-1-1 despite having palpable stroke symptoms. His face was beginning to slump, he lost control of his left hand, and he was having difficulty speaking.

What Harrigan didn't know at the time was that UW Health Partners Watertown Regional Medical Center, the hospital he was transported to by ambulance, had just implemented a telestroke program connecting them to the University of Washington Hospital and Clinics in Madison on a 24/7 basis.

A stroke specialist in Madison was able to evaluate Harrigan using remote brain imaging technology and videoconferencing tools. As a result, he was given tissue plasminogen activator (tPA), a clot-busting drug which needs to be administered within the first three hours of an ischemic stroke in order for it to be effective.

"I am clearly very, very blessed and lucky that I happened to be able to take advantage of the telestroke program," says Harrigan. "I'm certain that without it I would have had more permanent damage and probably even more serious complications, including life-threatening ones in my opinion. It really could have been very serious."

Instead, Harrigan was transferred to the University of Washington clinic in Madison, where he spent the next week in their ICU before he was transferred to cardiology. He was eventually diagnosed with an atrial fibrillation.

In May, the American Heart Association (AHA) and American Stroke Association (ASA) published groundbreaking statements recommending the use of telemedicine technology on stroke patients. The AHA and ASA cite that the US has a mere 4 neurologists per 100,000 people who need to care for over 780,000 acute strokes per year, many of which occur in parts of the US that do not have access to acute stroke services.

The statement encourages the use of telemedicine technology to bridge the gap by providing medical specialists with the data necessary to assist remotely-located bedside clinicians in stroke-related decision making for patients.

Here are three institutions in the country that have implemented telestroke centers and the benefits and challenges they face.

Reducing the burden of stroke in Wisconsin
Justin Sattin, MD, leads the stroke program at the University of Washington School of Medicine and Public Health, which performed Harrigan's telestroke consultation. He describes the telestroke technology in Watertown as a "glorified IV pole" that can be moved anywhere in the hospital where the tools are needed.

It is equipped with a computer and flat screen monitor, which displays the physician's image. At the top of the pole is a high quality camera. To provide a consultation, the on call physician needs a computer with Internet access, a Web cam, and client software.

"The problem is that there's a lot of stroke out there," he says. "But, there really aren't many neurologists and, certainly, not that many stroke specialists."

As a result, Sattin says that healthcare professionals lean on stroke specialists, requesting consultations for any patient who has an acute change in their neurological function. For Sattin, this means he makes many trips to the emergency room for patients who end up getting diagnosed with everything from infections to seizures.

With the telestroke technology, stroke specialists are able to remotely treat patients who may have otherwise not been able to access care, making better use of their time. Sattin believes that telestroke technology could also become a "game changer" from a public health perspective by reducing some of the barriers of giving tPA to patients.

At first, Sattin said that the hospital in Watertown objected to the telestroke services because they didn't see many stroke patients, and saw even fewer patients who were candidates for tPA. However, now that the telestroke program is in place, Sattin says the hospital calls his facility more frequently than they predicted they would.

"More of their stroke patients have become tPA candidates," which, he says, is the whole point of the program.

In fact, Sattin says they treated six out of the first 12 telestroke patients using tPA. According to Medicare data, he says only a mere 2.5% of patients receive the drug.

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