When it comes to treating stroke patients, time is of the essence.
According to medical studies, different types of stroke can be treated differently and have different windows of time to get to patients to the hospital. Everyone can agree though, the faster the treatment the better.
A team at the Charlottesville, Va.-based University of Virginia Health System, which includes a 604-bed level I trauma center, understands this and has begun a pilot that will equip local ambulances with a mobile telemedicine kit. The pilot, called Improving Treatment with Rapid Evaluation of Acute Stroke via Mobile Telemedicine (iTREAT), aimed to give stroke neurologists at UVA Health System the ability to diagnose patients before they reach the hospital.
“We often say ‘time is brain,’ that’s kind of the motto with stroke care,” explains Andrew Southerland, M.D., a stroke neurologist at UVA Health System. “If this is a disease that you want to treat the sooner the better, why not take advantage of this simple teleconferencing, make it mobile, and put ourselves in the back of the ambulance with the patient and paramedics and start the treatment process.”
Southerland says the standard of care around stroke treatment in this area is the timely administration of tPA (tissue plasminogen activator). That medicine helps restore blood flow to the brain during an ischemic stroke and decreases the chances of long-term disability. However, it’s only effective within three hours of stroke symptoms. According to studies from UVA Health, fewer than 5 percent of all stroke patients receive tPA.
The issue is vital for UVA Health. Both Southerland and Sherita Chapman, M.D, another neurologist at UVA Health, say, the hospital treats a significant number of the neurology patients coming in via ambulance from rural outposts. In these peripheral areas of central and southwest Virginia, it can take 30 minutes or longer to get these patients to the hospital.
UVA Health is working with the Thomas Jefferson Council for Emergency Medical Services, a local EMS agency organization covering multiple counties in the area, to equip the vehicles with the telemedicine tool kit. The project is currently in the testing phase and the team says it hopes to go live with it at some point in early 2014.
The kit includes iPads, videoconferencing technology from Cisco, a high-speed modem, and a magnetic antenna. This is fairly basic technology, and the main question, Southerland says, is whether they can maintain the wireless strength to do audio/visual teleconferencing with a moving ambulance. Luckily for UVA Health and the iTREAT team, the health system has a “Center for Telehealth” that provides technical support.
“We’re just the physician side, which is a small portion of the success. We have to have great technical support,” says Southerland, who adds that despite a relationship with this center, a 4G wireless infrastructure, and a partnership with Verizon Wireless, “I’m sure there will be obstacles along the way. The connectivity is the limiting step to success.”
From a patient safety perspective though, Chapman isn’t concerned. Mainly, she says, because they’ve come to an agreement with the EMS providers that the patient’s status takes precedent over everything. Thus, if they are unstable or something major happens, it will be looked at before the video conferencing software is turned on.
“We are doing a lot of feasibility testing and have thought about doing simulations to make sure we’ve covered the safety of this study before proceeding with real patients,” Chapman says.
In terms of clinical measures, Southerland says they will look at quality-adjusted life-years. While that may be a ways away, he projects that eventually they should be able to understand the impact the telemedicine treatment has on decreased odds of disability and overall cost dollars (looking at people who can go home vs. people who go to a nursing home environment).
At this point, UVA Health is still looking for additional funding for this project. The iTREAT team has set up a crowd sourcing page for donations looking to raise $10,000 to equip two local ambulances with the technology. It has submitted several grants and is waiting to hear back on those. However, the real money could conceivably come when it demonstrates proof of improved outcomes. He says the elasticity of potential it provides is one vital element to getting those federal dollars.
“The beauty of mobile telemedicine is it’s new, it’s innovative, it’s easy, and stroke is one small area where it has applicability,” Southerland says. “You have to look at all of the funding opportunities at your disposal. If it’s a good idea then it will be done and funding is a small step to make that happen.”
