In 2009, 338-bed South Fulton Medical Center in Atlanta offered only limited inpatient neurological services. Then along came telemedicine. A plan developed by Karim Godamunne, MD, MBA, SFHM, in conjunction with Atlanta-based Eagle Hospital Physicians, supplied the medical center with on-call teleneurologists working in concert with the HM program, under Dr. Godamunne’s direction.
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In the first full year of the program, the medical center increased its volume of stroke patients by 80%. The successful integration of telemedicine and hospital medicine, in conjunction with neurology and nursing, has become a template for a soon-to-be-launched partnership with a hospital in Tennessee.
“So it’s really a multidisciplinary, systemized approach to stroke care,” Dr. Godamunne says.
Some telemedicine programs use remote-controlled robots, such as InTouch Health’s RP-7, that can be driven to the bedside of a patient with a suspected stroke. Mary E. Jensen, MD, professor of radiology and neurosurgery at the University of Virginia in Charlottesville, says impressive gains in imaging may be making even that futuristic-seeming technique obsolete. Telemedicine already is using more portable monitors—and in the near future, perhaps, iPads—as visual conduits. A linked system that delivers high-resolution CT and MRI scan results can help Dr. Jensen and stroke neurologists look for hemorrhaging or a large evolving infarction in patients at 25-bed Bath Community Hospital, a two-hour drive to the other side of Virginia’s Blue Ridge Mountains.
After confirming the absence of both complications, a stroke neurologist can give the all-clear for delivery of IV tPA, while Dr. Jensen can determine whether a patient is a candidate for interarterial tPA or mechanical extraction of the clot. And for cases that require it, secure “cloud-based” applications that use the power of the Internet can let multiple providers have a virtual meeting and reach a joint decision about patient care without leaving behind sensitive data that could be fodder for misuse.
“The technology, it’s just developing at such an incredible speed. And I find that very exciting,” Dr. Jensen says.
As the telestroke concept expands, medical centers are departing from the typical hub-and-spoke model in which a large central institution provides services for a ring of rural or underserved areas. Kevin Barrett, MD, MSc, assistant professor of neurology and stroke telemedicine director at the 214-bed Mayo Clinic in Jacksonville, Fla., says the clinic’s partnership with 201-bed Parrish Medical Center in Titusville, Fla., about 130 miles to the south, is with a facility that’s nearly the same size.