Pamela Kimmel, RN, BSN, with a telestroke robot (nicknamed “Rosie”) in the NSICU at UC Health’s University Hospital. Photo by Cindy Starr / Mayfield Clinic.
The new UC Health Telestroke Network has already paid dividends for patients at Dearborn County Hospital in Lawrenceburg, Ind. More than half a dozen patients at the hospital have been examined, via a telestroke robot, by members of the UC Stroke Team since the system was implemented April 30.
The robots enable audio-video communications in real time between a patient and clinician at a distant site and a UC Stroke Team member (with laptop) wherever he or she is at the time. The Stroke Team physician can interview the patient and observe while the patient performs simple tasks, such as touching his or her nose or repeating words or phrases. The physician also will be able to confirm or rule out facial droop and will even be able to see the size of the patient’s pupils.
None of the patients examined at Dearborn County via telestroke thus far has been given the potent clot-busting drug TPA, said Pamela Kimmel, RN, BSN, Telestroke Program Manager for the University of Cincinnati Neuroscience Institute. But on the very first night the system was in place, the robot changed a physician’s recommendation for treatment. “Based on his consultation over phone and what he was hearing, the physician felt that he most likely would have treated the patient with TPA,” Ms. Kimmel said. “But because he had the ability to actually examine the patient via the robot, he determined that the stroke was not severe enough to warrant the TPA.”
Stroke is a leading cause of severe adult disability and the fourth leading cause of death in the United States. Time is precious when a stroke occurs, as brain cells lacking oxygen begin to die. People who have suffered an ischemic stroke — one caused by a blood clot — can reduce or eliminate their risk of death and disability through early treatment and the administration of the TPA within 3 to 4 ½-hours of the onset of the stroke’s first symptoms.* At the same time, this drug does carry a risk: a small minority of patients will experience bleeding in the brain. A patient who avoids unnecessary administration of TPA therefore avoids that risk.
The telestroke program was launched at University Hospital in March 2012, with one robot placed in the Emergency Department and another in the Neuroscience Intensive Care Unit (NSICU). A third robot was placed at West Chester Hospital’s Emergency Department in May.
“The Dearborn County staff has praised our doctors’ ability to beam in and examine their patients,” Ms. Kimmel said. “They view it as a simple and effective program, and we’ve had several situations that have proved its value.”
“The stroke team physicians are experts in their field,” said Roger Howard, Director of Clinical Services and Facilities for Dearborn County Hospital. “By using this telemedicine system, the specialist is brought to the patient in a matter of minutes.” Working collaboratively, he added, the Dearborn County Hospital Emergency Department physician and the University Hospital Stroke Team physician can also determine whether the patient should remain at Dearborn County or be transferred to the UC Comprehensive Stroke Center for tertiary stroke care.
In an unexpected benefit of the telestroke program, Ms. Kimmel said, Dearborn County physicians are consulting the UC Stroke Team more frequently than before. “They might have felt they were disturbing a busy physician in the past, but because we have this technology in their emergency room, they feel we definitely want them to call us about any patient who presents with a symptom that could be related to stroke.”
Meanwhile, the UC Neuroscience Institute and University Hospital plan to continue expanding into rural and underserved areas. They will implement a telestroke system at Clinton Memorial Hospital in Wilmington, Ohio, in July and expect to be present in up to five additional hospitals during the next year.
“UC Health has taken on this mission,” Ms. Kimmel said. “They’re going to use robot technology to take the level of expertise of our stroke physicians beyond the 275 beltway and out to the underserved areas of the various surrounding states.”
– Cindy Starr
