Treating stroke victims is a race against time. The sooner the victim is treated with medication that breaks up blood clots and restores blood flow to the brain the better the chances the patient will suffer less permanent damage including losing muscle control, mobility and the ability to speak.
Each year approximately 795,000 people suffer a stroke. About 600,000 are first attacks and 185,000 are recurrent attacks. Nearly three-quarters of strokes occur in people over the age of 65, according to StrokeCenter.org. But less than 30% of stroke victims receive clot-busting medication inside a recommended window of an hour or less for maximum effectiveness, according to figures from healthcare delivery network Kaiser Permanente.
A new study shows how telemedicine can assist in getting stroke victims faster treatment. In a new study that included data from stroke patients being treated in 21 Kaiser emergency rooms in Northern California, patients who were diagnosed as having a stroke by a neurologist and a radiologist via a telehealth consultation received clot-busting medication intravenously much faster than the 60-minute “door to needle” guidelines from the American Heart Association and American Stroke Association.
Specifically, when emergency room staff contacted a staff neurologist and a radiologist via a telestroke cart, which includes a video camera and access to patients’ electronic scans and test results, patients received anti-blood clot medicine in an average of 34 minutes. Of the more than 300 patient results Kaiser used in its study, 87% of stroke patients received the intravenous medication in 60 minutes or less, 73% in 45 minutes or sooner and 41% in 30 minutes or less.
“When a stroke happens, minutes matter,” says Dr. Mai Nguyen-Huynh, a vascular neurologist and research scientist with the Kaiser Permanente Division of Research. “Faster treatment intravenously dissolves the stroke-causing clot and restores blood flow to the brain.”
Video neurologist consults are a key part of Stroke Express, a stroke treatment plan Kaiser Permanente began rolling out to its Northern California hospitals in September 2015 and completed in January 2016. All Kaiser Permanente emergency departments in Northern California are now equipped with telestroke carts, which enable the stroke specialist to conduct a patient’s neurologic physical exam online even when they are not present in the emergency room, Kaiser says.
“Processes that used to happen sequentially during a stroke alert, one after another, are now happening at the same time, allowing us to quickly, safely and confidently provide evaluation and treatment to stroke patients who can benefit,” Nguyen-Huynh says.
Kaiser did not include any telehealth consults that may have occurred at the scene by paramedics or on the trip to hospital. Kaiser, which serves 11.8 million members in eight states and the District of Columbia, also has yet to say if Stroke Express is being rolled out to all of its 39 hospitals.
But more hospitals are using telehealth to expedite stroke care and some hospitals and health systems are doing so with a big emphasis on mobile. The NewYork-Presbyterian Telestroke Initiative has been deployed at NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian/Lower Manhattan Hospital by the NewYork-Presbyterian Health System. The program uses video conferencing and data sharing to allow continuous coverage for stroke care with rapid evaluation by a neurologist with stroke expertise.
As part of the program, NewYork-Presbyterian has a mobile stroke treatment unit, which is a specialized emergency vehicle with CT imaging capability. New York’s 911 system dispatches the vehicle through the Fire Department of New York directly to a patient showing signs of a stroke.
By wirelessly transmitting the CT scan to a NewYork-Presbyterian neurologist, the amount of time from the onset of symptoms to the delivery of care is significantly reduced, the hospital says. The mobile unit carries medications specific to diagnosing and treating strokes and can be delivered immediately upon diagnosis.
NewYork-Presbyterian didn’t say how many mobile stroke telehealth sessions have been conducted thus far. But telehealth has cut about seven minutes off the time it previously took to diagnose a stroke on the way to the hospital, NewYork-Presbyterian says.
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