Telestroke Network Proving its Value in Reaching Remote Patients
Alice Ford was eating her supper and watching television when all of a sudden, she couldn't see half of the screen. She turned to her husband, Tony Howell, and could only see the left half of his face.
"I'm thinking 'Oh, this will pass. I've got a little eye problem.'"
But when she couldn't rub the problem away, she left messages for her physician and her ophthalmologist. She was lucky. The ophthalmologist called back quickly and gave her a couple of quick tests over the phone.
"He said, 'You don't have a problem in your eye. You have a problem in your brain.' He said go to the hospital right away.''
Ford was diagnosed by Steve Williamson, MD, an emergency room physician at Catawba Valley Medical Center who, using a robot electronically linked to a Wake Forest Baptist Health neurologist, was able to discuss treatment options. Within three hours of first displaying her symptoms, Ford was given the clot-busting drug called tissue plaminogen activator, or tPA. Studies have shown that when used up to 4½ hours from the onset of symptoms, tPA has proven effective for improving functional outcomes and limiting damage after ischemic stroke.
Charles Tegeler, MD, previously the longtime director of the Comprehensive Stroke Center of Wake Forest Baptist and now director of the Telestroke Network, says the mantra "time is brain'' continues to be paramount when it comes to stroke. Recognizing, diagnosing and treating stroke quickly is key to preventing long-term damage.
The telestroke network was created to assist hospitals throughout North Carolina that did not have 24-hour access to a neurologist or stroke specialist in emergency departments. Statistics showed that nearly 20 percent of North Carolinians live in a county without a comprehensive stroke center that specialize in delivering tPA and other acute stroke treatments.
With the robotic video teleconferencing system, neurology experts from the Wake Forest Baptist network "hub" can "see" all they need from afar in order to consult with emergency physicians at any of the 10 hospitals that are part of the network, such as Catawba Valley Medical Center.
By working with the physicians giving care, the team determines who are the best candidates to be treated with tPA, the top drug to break up clots but one that needs to be carefully considered based on a patient's risk factors.
Telestroke Network's Advantages
Tegeler says Wake Forest Baptist's telestroke network has been used about 600 times in its three years, and about one-third of patients have received tPA as a result of the network consultations.
"That's a big change and we believe that's made a difference in outcomes for stroke,'' he says.
One of the advantages of the telestroke network is that it connects physicians who are more experienced in recognizing aspects of stroke with the emergency physicians or other physicians caring for the patient.
Williamson, the emergency room physician at Catawba Valley Medical Center, says Ford had an isolated stroke with just the specific vision issue.
"In 20 years, I don't think I've ever seen a case like that,'' he says. "And she had no other problems. I mean, she was perfectly fine.''
Being able to consult with Wake Forest Baptist neurologists offers something new, Williamson says.
"They have experience with similar cases,'' he says. "That's the advantage of having this system. The people helping to make the decision are doing a lot of volume. And volume in medicine is important. If you see a lot of the same thing, you get good at it.''
Although patients are sometimes surprised when the Wake Forest Baptist "doctor'' is wheeled in and appears on a television screen, Williamson says he's never heard anyone complain about not trusting the physician on the other end.
"It's a little like Star Trek," he says. "If I've got a doctor talking to me on a computer, it must be better.''
To Ford, 70, the experience was both crucial and amusing. She told her story just a week after her stroke, which occurred in January.
"I'm thinking that the robot saved my life in the fact that I don't have any direct residual effects at this moment,'' she says. "Not that it was fun, but it was really kind of neat.''