ST. MARYS — In hopes of bringing advanced stroke care to the area, Joint Township District Memorial Hospital has joined Ohio State University’s stroke telemedicine network.
The network connects rural hospitals with specialists in a cost-effective, timely manner, creating better patient outcomes. Joint Township District Memorial Hospital Director of Emergency and Ambulatory Care Services Lana Hinders said the hospital was approached to join the network, which is funded through the Ohio Department of Health, last year.
“Ohio State University invited us to hear a presentation on their telestroke initiative back in November of 2011,” Hinders said, noting representatives from Ohio State University met with hospital executives. “Initially, they had a focus on the southwestern part of Ohio, but because the program has been so successful at the initial sites, they were later then approved to expand the program into other areas of the state, so they next chose the northwest region of the state.”
After weighing the pros and cons of the approach, Hinders said hospital executives found the Ohio State University stroke telemedicine network superior to similar networks that had been presented to the hospital.
“The three things that stuck out to us in the presentation were that they have stroke experts that are able to perform both surgery and endovascular surgery, so that if they were in an interventional lab and something went wrong with the patient, they wouldn’t have to leave that lab and go into surgery, which has a different team and (may cause) delays in care,” she said. “They could have that same team stay in the same suite and just go from an interventional procedure to a surgical procedure.”
Hinders noted Ohio State University assured hospital executives the stroke team would be available on-site 24/7 and also agreed to participate in a hospital program.
“They were willing to actively participate in what we have here, a process improvement program, where we look at all of our stroke cases and evaluate the quality and try to identify opportunities for improvement,” she said. “OSU was willing to come back and give us real-time feedback when we had stroke alerts as well as help us to identify if we were meeting targets and if we weren’t meeting targets, where they thought our process should improve.”
Participation in the stroke telemedicine network, which went live at Joint Township District Memorial Hospital in September, begins when the hospital is presented with a patient that has stroke-like symptoms.
“We now activate a stroke alerts,” Hinders said. “As soon as we become aware that a stroke patient or a patient with stroke-like symptoms has presented to our facility, we actually overhead announce stroke alert, and that mobilizes our stroke team. From the patient’s perspective, sometimes that is done before they even arrive at our facility.”
Local emergency responders have been trained to recognize the symptoms of stroke, she added, and have been directed to alert the hospital so a stroke alert can be activated and a team can be assembled.
“The patient will see a stroke team activated, and that team includes the ER physician, nursing staff, somebody from radiology, somebody from lab, somebody from pharmacy, somebody from the cardiopulminary — a lot of services will be waiting for them upon arrival or even prior to arrival,” she said.
As part of the process, patients will be assessed by a specialist via a reach cart.
“We do have what we call our reach cart, which is essentially a robot with advanced video equipment, in the room with the patient,” Hinders said. “The patient will be interviewed and assessed by an OSU neurologist or consultant right in the room, and his or her image is projected to the patient through the computer screen. The robot really looks like a person, even though it’s just a cart with a computer monitor mounted on it.”
The hospital’s participation in the stroke telemedicine network also allows patients better access to the clot-busting medicine, tPA.
“That definitely improves patient outcomes if it’s appropriate for the situation,” Hinders said. “That’s not new or different, and we’ve been able to have that option in the past, but many of our physicians have been a little reluctant to evaluate a patient for that because you have to have a neurologist or neurointerventionalist be involved to be able to give that medication. So if you can’t get access to a specialist who is willing to consider that treatment option in a timeframe that appropriate for that treatment option, sometimes it’s not an option.”
After the consultation, the patient is able to choose a facility for additional care.
“It’s always their choice to go to a facility of their choice, so it’s really just about having a consultant available for evaluation, but it does not mandate that a patient has to go to Ohio State University,” Hinders said. “They can certainly go to any other facility that has a physician capable of caring for their condition based on the treatments they have been provided here.”
In its first two months of participation in the stroke telemedicine network, Joint Township District Memorial Hospital is already seeing better outcomes.
“We are very excited with our early results,” she said, noting the hospital has had four stroke alerts so far, which is what Ohio State University predicted the hospital would have. “We were thrilled that we are meeting those targets, and our outcomes, we have been meeting the quality metrics associated with this new process on all of the cases that we’ve had.”
One patient was able to receive tPA, she added.
“We saw marked improvement from the way the patient presented upon arrival to the way that they were when they departed our facility,” she said. “That’s what it’s all about is that outcome, improving the patient’s condition and decreasing the chance that they’ll have a long-term negative outcome from stroke. It was exciting for the staff to see that process and all their hard work come to fruition in an outcome.”
The network, she said, is bringing the community access to the specialized care in a timely manner.
“This initiative brings rapid access to advanced stroke care to this facility and to the community,” she said. “It’s access that they might not normally have. Patients with stroke symptoms are evaluated as quickly as possible by the best stroke team in the region.”
She noted the importance of time when dealing with stroke.
“With stroke, every second counts,” Hinders said. “Getting evaluated and treated within the first three to six hours of symptom onset greatly increases their chance to survive and reduces the risk of suffering a loss of functions secondary to stroke.”
Hinders stressed the importance of getting to the hospital quickly.
“When stroke strikes, we’re ready, and they are the most important part of that equation,” she said. “They need to seek care in a timely manner.”