A Cleveland Clinic mobile stroke treatment unit (MSTU) was able to initiate faster treatment for its stroke patients compared to patients treated in the emergency department by utilizing telemedicine, according to a research study published in JAMA Neurology.
Typically, MSTUs have on-site treatment teams that include vascular neurologists who can provide thrombolysis in the prehospital setting faster than treatment in the hospital. According to the research study, “These units can be made more resource efficient if the need for an on-site neurologist can be eliminated by relying solely on telemedicine for physician presence.”
The objective of the study was to “test whether telemedicine is reliable and remote physician presence is adequate for acute stroke treatment using an MSTU.”
For the purpose of the study, MSTUs were equipped with mobile computed tomography system and staffed by a registered nurse, paramedic, emergency medicine technician and a CT technologist. A vascular neurologist evaluated the first 100 patients via telemedicine, and a neuroradiologist remotely assessed images obtained by the mobile CT.
The study compared the evaluation and treatment of patients on the MSTU with a control group of patients brought to the emergency department via ambulance during the same year. Process times were measured from the time the patient entered the door of the MSTU or emergency department.
According to the study, the patients in the study group waited 32 minutes from the time they entered the door of the MSTU to the time they were administered intravenous thrombolysis, compared to 58 minutes for the control group.
The use of telemedicine, in which the CT scans were read remotely without waiting for the patient to see a neurologist on-site, helped to speed the time of delivery of critical, potentially life-saving, medication.
The study authors wrote, “We demonstrate successful incorporation of telemedicine into the MSTU in Cleveland, rendering the presence of a physician on the mobile unit unnecessary. During the first three and a half months of service, the MSTU managed and transported 100 patients who had initial symptoms suspicious of stroke based on the emergency call intake. The MSTU was able to approach all neighborhoods of Cleveland, and patient race/ethnicity characteristics matched closely with the city statistics. Most assessments by the city EMS before transferring the patient into the MSTU were short. Using telecommunication, we were able to ensure safe and timely transfer of patients based on their geographic location.”
And, the study authors concluded, “It is feasible to perform prehospital stroke evaluation and treatment using a telemedicine-enabled MSTU. The system would allow a physician to cover multiple MSTUs and broaden the geographic coverage, rendering the concept more efficient and cost-effective.
