A new technology that’s more convenient for doctors and results in faster treatment for patients has debuted in both Nebraska Medicine emergency departments within the past few weeks.
“We can’t train enough neurologists to support the growing needs of our aging population,” says Marco Gonzalez, MD, neurologist and Telestroke champion. “Telestroke is helping us to fill that gap with the aid of technology. We’re bringing the stroke expert to the bedside.”
Stroke treatment is protocol driven. Alteplase is the only FDA-approved drug for the treatment of acute ischemic stroke, but it must be given within four and a half hours of stroke symptom onset. As a result, only about 10 percent of eligible patients receive the treatment, Dr. Gonzales says. Even more advanced treatments like a thrombectomy must be done within six hours, so either way, prompt diagnostics and consultations are essential to quality outcomes.
The Telestroke program has been in the works for more than a year, says Denise Gorski, who began laying the foundation for the program as a clinical program coordinator in Neurosciences before stepping into her current role as director of Diagnostics at Nebraska Medicine – Bellevue.
“Strategic planning for Neurosciences identified Telestroke as a solution to improve access to neurology care at the bedside,” Gorski says. “Emergency physicians welcome it, as it helps them make the best treatment decisions and reduce unnecessary transfers.”
Moving forward, interdisciplinary teams across Nebraska Medicine worked to identify the best technology and processes to make the solution a reality.
In a nutshell, here’s how the Telestroke protocol works:
•A patient presents with recent onset of stroke symptoms (or first responders indicate a likely stroke)
•Someone in the Emergency Department pages the neurologist on call for Telestroke
•The neurologist calls and speaks with the attending emergency physician
•The neurologist uses an app on their phone or tablet to connect to the Telestroke unit
•The nurse brings the Telestroke unit into the patient’s room, introduces the neurologist and helps with the exam
•The neurologist explains the process, conducts the exam and develops a treatment plan with the patient/family/emergency care provider
The Telestroke unit looks like a large, controllable camera screen that acts similarly to the common smartphone application FaceTime. Special adaptations to the Telestroke unit have made it much more clinically useful.
“The Telestroke unit has a number of features to make it useful to clinicians,” says Kyle Hall, Telehealth program coordinator. “It has a wide angle lens to view the patient, family and the care team as if in the same room. It can show the patient’s CT scans to the neurologist and patient. It can zoom on a patient’s eyes and has a stethoscope to help with diagnoses.”
Plans to extend Telestroke to other Nebraska hospitals are under development, Hall says. In the meantime, Nebraska Medicine will focus on optimizing the use of Telestroke to intervene more often and help give stroke patients a higher quality of life as they recover.
“Time is brain, so the sooner we treat, the better the outcome,” says Dr. Gonzalez.