They may look like ordinary clinical carts, but with the computer monitor and video technology attached, they are helping to save lives and improve outcomes for stroke patients.
Fayla Anderson, BNS, CNRN, stroke services program coordinator, says these carts are equipped with accurate, highly sensitive cameras that allow Baystate Health’s neurologists to remotely evaluate stroke patients at hospital locations where there is no neurologist on call. The main goal of the Telestroke Program is to evaluate whether patients are good candidates for Tissue Plasminogen Activator (TPA) so that clot-busting drug can be administered in a timely manner.
Ms. Anderson says the program began several years ago at Baystate Mary Lane Hospital in Ware and Baystate Franklin Medical Center in Greenfield, and has recently expanded to Baystate Wing Hospital in Palmer and Noble Hospital in Westfield.
When a patient experiencing stroke-like symptoms is admitted to one of these Emergency Departments, a page goes out to the neurologist on call at Baystate Health. A telestroke cart is wheeled into the patient’s room, and the neurologist and patient are connected via software similar to Skype and a video camera on the cart.
“Patients can see the neurologist and interact on-screen,” Ms. Anderson says. “The neurologist can actually view the patient, zooming in and out, moving the camera around to conduct a full neurological exam remotely.” The system is secure to protect patient confidentiality.
Role of Telepresenters
As essential as the technology are the “telepresenters,” either nurses or medical assistants, depending on the nature of the consult, who are with the patients and help conduct the exam. Billie Gammell, RN, a nursing supervisor at Baystate Franklin Medical Center, is a telepresenter who has worked with a variety of specialists using telemedicine technology, including Rajiv Padmanabhan, MD, a Greenfield-based neurologist with a subspecialty in vascular neurology, who is also part of the stroke team in Springfield.
“I learned his exam style, and how to anticipate what he may ask for next,” says Ms. Gammell, who adds that this might include testing for reflexes, strength, balance, coordination, vision, speech, and mental status; and checking the patient’s heart and lung sounds with a stethoscope attached to the computer, which the doctor can hear through a set of earphones on his end.
“The knowledge and skill of the telepresenters is key,” says Dr. Padmanabhan. “In addition to managing the technology, they help to make the patient feel comfortable, and ask any clarifying questions so the patient and family understand what is going on. A good telepresenter makes it a better experience for the patients, and also easier for the physician.”
Saving Time, Saving Brain
Computer technology also allows the neurologist to view laboratory and scan results remotely. After a decision is made about TPA and the drug is administered, Ms. Anderson says the patient can then be safely transported to Baystate Medical Center, if further diagnostics and procedures are considered necessary.
For patients in Franklin County or the Palmer, Ware, and Westfield areas, saving that initial 30 to 45 minutes in an ambulance for an evaluation can save brain function. “With Telestroke, we don’t have to transport patients for that initial evaluation anymore,” Ms. Anderson says. “They get a neurological consult right when they need it, with no neurologist in the building.”