Technology linking stroke patients and the care team at UnityPoint Health® – Trinity with a neurologist specializing in stroke treatment from Loyola University Medical Center is helping to close the window of time needed to assess and begin treatment in the emergency department.
In January, Trinity began working with Loyola University Medical Center’s Virtual Medicine program to improve access to specialists for stroke patients across the community. The program has recently been expanded to both the Trinity Rock Island and Trinity Bettendorf campuses. Loyola neurologists specializing in stroke care are on call 24 hours a day, seven days a week and use the telemedicine device to collaborate with Trinity physicians in diagnosing and treating patients.
The InTouch Lite Robot, now active at Trinity, is a secure two-way audio/video link that allows immediate access for the neurologist, emergency physician, patient, family and caregivers to see and talk with each other to effectively assess the medical situation and discuss critical next steps. The connection allows the off-site neurologist to check vital signs, examine CT scans, review the patient chart and visually examine the patient.
“The neurologist has access to vital information in real time. It is as if they are in the room, but physically they are not,” said Amy Mundisev, RN, nurse educator for Trinity’s three Quad-City emergency departments. “Time is a major factor in the treatment of a stroke because of the potential damage an active stroke can cause in the brain,” she explained, adding, “Time equals brain cells.”
The Loyola Virtual Medicine program provides access to the neurologist within minutes of the patient’s arrival. “To be able to provide this service is phenomenal. It gives a group of patients access to care and a specialist very quickly,” Trinity stroke coordinator Paula Maddox, RN, said.
Detection of a stroke usually is made by a patient’s family or a friend. What happens in response can be instrumental to survival and recovery.
“If families suspect a stroke, we ask that they still call 911 and allow emergency responders to transport the patient to the hospital,” Maddox said. “They can assess the patient, start IVs and get treatment started.”
Emergency responders also notify the hospital emergency department of a possible stroke patient on the way, which sets off a series of communication messages that a stroke alert is in-route to the hospital, which means the team is waiting when the patient arrives. The Loyola Virtual Medicine neurologist (a stroke specialist) is contacted, and a team of caregivers – from ED physicians, nursing, lab, imaging, respiratory and chaplaincy to assist with family – is coordinated.
The CT scan helps responders determine what type of stroke is involved and whether a “clot- busting” medicine is appropriate for use. The ED physician and the neurologist coordinate care as more information is obtained and the Telestroke “robot” with the videoconferencing equipment is brought in.
The Telestroke camera linking the patient and neurologist can be run by the physician or a nurse. Mundisev said the ED nurses underwent extensive training prior to implementation and have ongoing requirements to stay current.
Since being implemented in late January, Trinity has had more than 50 patients seen by the technology, with 96% of the telestroke consults connected to the stroke specialist within five minutes or less. Positive feedback has been received from families and patients, and good outcomes have been experienced, said Dr. Michael Barr, medical director for Trinity’s stroke program.
“Having this kind of rapid access to a neurologist who specializes in stroke just adds another layer to the protocols we already have in place for stroke treatment,” he added. “Telemedicine stroke technology truly can enhance the quality of life for our stroke patients.”
How to Identify the Warning Signs
The Trinity Stroke Team recommends following the B.E. F.A.S.T. acronym for identifying the warning signs of stroke:
- Balance: Ask the person to walk. Are they having trouble with their balance?
- Eyesight: Ask the person to read something. Do they have sudden trouble with their vision?
- Face: Ask the person to smile. Does one side of the face droop?
- Arms: Ask the person to raise both arms. Does one arm drift downward?
- Speech: Ask the person to repeat a simple sentence. Does the speech sound slurred or strange?
- Time: If you observe any of these signs (independently or together), call 911 immediately.
(Source: The Joint Commission)