Patient Care

ONLINE EXCLUSIVE: Telestroke Expands its Reach


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.

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.

“Because of local neurologists not being enthusiastic about covering emergency cases, telemedicine is now expanding into larger centers where there’s a shortage of inpatient neurology coverage,” Dr. Barrett explains.

Local hospitalists are central to the model’s success, he says, because most of the ischemic stroke patients aren’t falling under the traditional “drip and ship” method, in which they’re treated remotely, then transferred to tertiary-care centers with neurological expertise. The telemedicine-aided ability to manage more patients locally, Dr. Barrett says, is ultimately better for them, their families, and the hospital.

Bryn Nelson is a freelance medical writer in Seattle.

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