When Time Is of the Essence
Many people are aware that it’s important to get care quickly for stroke patients, but they may not know just how crucial fast action can be.
“Left untreated, a stroke victim can lose millions of brains cells every minute,” says Daniela Zambrano, MD, a vascular neurologist at The University of Vermont Medical Center. “That’s why we’re always looking for new tools to help us evaluate and treat these patients as quickly and comprehensively as possible.”
One of these tools is Telestroke, a UVM Health Network eHealth program that connects stroke care across affiliate hospitals Elizabethtown Community Hospital, Champlain Valley Physicians Hospital and UVM Medical Center. Kicked off in 2019, the program is built on the idea that technology can give stroke patients a better chance of making a full recovery by quickly connecting them with appropriate specialty care, even if it is based at another location. Telestroke uses mobile telemedicine carts to help neurology specialists get involved early in a stroke patient’s evaluation and work remotely with their emergency department colleagues at other locations to develop a treatment plan.
The collaboration is paying off, with UVM Medical Center and Champlain Valley Physicians Hospital recently receiving awards from the American Heart Association (AHA) for the level of care delivered to stroke patients across the UVM Health Network.
How It Works
Telestroke typically kicks in as soon as a suspected stroke patient arrives at a participating Emergency Department (ED) and is rushed to get a CT scan, a test that generates detailed images of the brain. The CT helps providers understand the scope of the damage. “We aim to get our patients to the CT in less than 25 minutes, which is consistent with AHA’s guidelines for stroke care,” says Colleen Bell, RN, clinical quality manager at Champlain Valley Physicians Hospital. “The faster we move, the more potential treatment options.”
While the patient is getting the CT scan, an ED nurse or doctor calls UVM Health Network’s Regional Transfer Center (RTC), which helps facilitate remote consultations between health care providers and arrange transfers if necessary. The RTC nurses build a case file and connect the ED provider with an on-call stroke neurologist at UVM Medical Center via telephone or video call. When time is of the essence, this eases the logistical burden on providers, allowing them to focus solely on their patient’s care and ensure it moves as swiftly as possible.
Critically, Telestroke’s mobile telemedicine carts allow real-time consultation, so that vascular neurologists at UVM Medical Center like Dr. Zambrano can quickly access the CT scan images while also examining the patient via video call.
“We get more eyes on the patient in the early stages of their evaluation, which allows us to deliver care as a team and can make a huge difference in their treatment and recovery,” says Dr. Zambrano.
Spotting the Signs of Stroke
Telestroke may get its name from the telemedicine technology that makes it possible, but it only works well if the ED doctors, nurses and EMS teams have the expertise to quickly spot the signs and symptoms of a stroke. Raising public awareness also plays an important role because it improves the odds that people recognize the symptoms of a stroke and act quickly to get medical help.
Ischemic strokes make up about 85% of all strokes in the United States. They occur when a blood clot obstructs the flow of blood and oxygen to the brain, which can cause the classic symptoms of weakness in the arms or legs, drooping on one side of the face, slurred or incomprehensible speech, inability to walk and loss of vision.
“Identifying theses signs early is crucial because treatment options become more limited after the first several hours,” says Bell.
In some instances, the delivery of blood-clot-busting medications called thrombolytics can start people on the road to recovery. Others may need more acute treatment, such as endovascular surgery, to remove a blood clot. In both cases, a patient needs to be transferred to a certified stroke center like UVM Medical Center.
However, with the assistance of Telestroke neurologists and the ED teams in local hospitals, the majority of stroke patients are able to receive the care they need locally, which means they can stay closer to home, their family and loved ones.
Network health care providers initiated Telestroke 90 times in 2021. Of those, 65 patients were treated at their local hospital, while 25 went on to receive treatment at UVM Medical Center.
“With the CT scan in hand, we have a much better idea of whether we can treat the patient here in Plattsburgh or if they’re a good candidate for thrombolytics or a thrombectomy,” Bell says. “We are able to care for stroke patients and give them the best chance of recovery because we have great teams at our affiliates and easy access to additional experts at UVM Medical Center via Telestroke. We’re able to give our patients the right care in the right place, and most importantly, at the right time.”