UAB Telemedicine for Stroke Care

Mar 19, 2019 at 05:04 pm by steve

Eric Wallace, MD

Every minute an embolism blocks blood-flow to your brain, 1.9 million oxygen-starved neurons can die.

If the stroke hits when you are near a medical center ready with imaging, a stroke neurologist on staff, and a cath lab team ready to remove the clot if necessary, your chances for surviving and recovering your independence are better.

But what if you are in a rural county when the first symptoms strike, miles away from the nearest stroke-ready hospital? Less than a year ago, that was the situation for much of Alabama, which is the number one state in both stroke incidence and stroke mortality.

"Alabama's BREMS emergency responders are trained to take patients showing stroke symptoms not just to the nearest hospital, but to the nearest stroke-ready hospital," UAB Telehealth medical director Eric Wallace, MD, said "The Demopolis area of west Alabama had some of the worst stroke statistics and not one stroke-ready hospital until last April when Bryan W. Whitfield Memorial Hospital became the first Telestroke site in our Telehealth network."

Although in theory any ER physician could administer the powerful clot-busting drug tPA (tissue plasminogen activator), in practice studies have shown that across the country physicians who don't have a background in stroke neurology are often uncomfortable using the drug and tend to underuse it. Determining whether a patient is a good candidate requires specialized training and experience. To work well, tPA must be administered within a strict window of time. In the past that was three hours, but today in some cases it can be pushed to four hours.

"Launching a Telestroke site involves a great deal of preparation. We train physicians, nurses and other staff for all three shifts. When a patient with stoke symptoms comes into the ER, a CT is immediately pushed to the cloud for a stroke neurologist at UAB to read. The neurologist consults by teleconference to discuss the diagnosis and whether TPA is indicated. If specialized care is needed, such as neuro-endovascular therapy to remove the clot by catheter, the neurologist facilitates transport and alerts the cath team here to be ready when the patient arrives," Wallace said.

In less than a year, six Telestroke sites have been launched in strategic locations around the state, and nine more are in line with a funding grant in place to develop them.

"There are also advantages to both patients and rural hospitals in having access to a stroke neurologist who can tell them when the problem isn't a stroke," Wallace said. "Some metabolic problems have similar symptoms and can be treated in the local hospital, which saves the patient from having to travel far from home, and it helps keep local hospitals open. It also helps UAB, which is often at 99 percent capacity, by freeing up beds for other patients."

The core purpose of the Telestroke program is to get the right time-sensitive care to the right patient when it is needed. In reviewing some CT images, other neurological conditions like tumors may be identified that need follow-up and referral.

"This points out the need for access to more specialists in underserved areas," Wallace said. "We are working on a prototype for general neurology services by Telehealth that we hope to roll out soon, as well as consults for nephrology and other specialized care that is difficult to access outside urban areas."

UAB physicians have been consulting with individual practices around the state, and the Telemedicine program plans to soon be using the capabilities of information technology for more in-depth monitoring of patients at home so that changes can be identified and addressed earlier.

"We want to use the full potential of IT to bring care to patients in acute situations, and also to help them stay healthier," Wallace said. "If we could help patients get better control of hypertension, blood sugar and other risks, some of these stroke emergencies might never happen."

"I'm proud to be working with Telehealth, and proud of UAB and the local hospitals, but most of all, I'm proud of so many people around the state who are working to bring advanced care where it is needed. It's wonderful to see thousands of people who care about better health outcomes in Alabama."

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