Monday, May 18, 2009

Videoconferencing can increase patient access to stroke specialists

Dr. Lee Schwamm

A patient arrives at the hospital with stroke symptoms. However, the hospital’s rural location means a stroke specialist is not available on-call, 24 hours per day. Instead, the Emergency Department team initiates a new technology to deliver care.

The patient and local clinicians are connected to a stroke specialist at another hospital via videoconferencing. Using high-quality, real-time videoconferencing equipment, the specialist can evaluate the patient’s symptoms and quickly order clot-busting treatment in time for it to be effective.

This technology, called telemedicine or telestroke, recently received the endorsement of the American Heart Association/American Stroke Association, which affirms in a May 2009 policy statement that remote exams using high-quality videoconferencing equipment are as effective as bedside stroke evaluations.

Telemedicine for stroke

There are about 800,000 stroke cases each year in the United States. Physicians must quickly evaluate these patients to determine if they’re eligible for a time-sensitive treatment called tissue plasminogen activator (tPA) that can save brain function and reduce disability but must be administered within three hours of the onset of symptoms.

Stroke and brain imaging specialists are often required to perform the evaluation. However, the United States has an average of only four neurologists per 100,000 people, and not all of them specialize in stroke. Telestroke coupled with teleradiology, which allows remote review of brain images, can broaden the reach of neurologists in a cost-effective and time-efficient manner, according to the statement.

“Telemedicine is an effective avenue to eliminate disparities in access to acute stroke care, erasing the inequities introduced by geography, income or social circumstance,” said Lee Schwamm, MD, lead author of the AHA/ASA policy statement on telemedicine and vice chairman of Neurology at Massachusetts General Hospital.

In New England, Dr. Schwamm helped to establish the Partners Telestroke Network. Using telemedicine technology, stroke specialists from Brigham and Women’s Hospital and Massachusetts General Hospital can examine, diagnose and recommend a plan of care for patients at 27 hospitals across the region.

“I control both the camera at my desk and the remote camera in the patient’s exam room, so I can see what I need to see and the doctor at the bedside can focus on taking care of the patient,” said Dr. Schwamm.

The AHA/ASA’s policy statement also recommends an increase in Medicare reimbursement for telestroke assessments, a streamlined credentialing process for telestroke providers and uniform national telemedicine licensure by state medical boards.

“We know we have a shortage of stoke specialists in the Unites States. There will never be enough to have a stroke expert at every hospital; therefore, telemedicine is a solution that can allow stroke experts to evaluate stroke patients immediately no matter where they present,” said Schwamm. “This will go a long way toward reducing the geographical, economic and social barriers to the best stroke care.”

Time is brain

During a stroke, time is brain, say stroke specialists.

“Once stroke symptoms start, every minute that goes by millions of brain cells are dying,” said Dr. Schwamm. “The goal is to try to stop that damage and reverse any symptoms as rapidly as possible.”

Recognizing the warning signs of stroke quickly and getting to a hospital can greatly improve chances for recovery. According to the AHA, the warning signs for stroke include:

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden, severe headache with no known cause

Learn more about the Stroke Service in the Department of Neurology

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