The Medical Minute: The beginning of a new era in stroke care

By Dr. Raymond J. Reichwein

Telemedicine, computer-based two-way audio/video direct patient care, has become popular over the past few years and has more recently moved into the stroke arena. Different acute stroke treatment computer-based systems are already on the market, with the ultimate goal of improving overall stroke care and patient outcomes, particularly in more rural and under-served physician communities and hospital systems, where access to stroke expertise and care may be limited or not timely.

An acute stroke -- a sudden brain injury caused by a vascular problem, such as a blocked or ruptured brain blood vessel -- can be devastating and possibly fatal. Stroke is the fourth leading cause of death in the United States and a leading cause of adult long-term disability. Many stroke survivors have some degree of disability, limiting their daily functional ability. Time is of the essence, or as we often say, “time is brain,” as millions of brain cells can die within hours after a stroke. So the first few hours are critical to improving patient outcomes, particularly with acute brain blood vessel blockages, or ischemic strokes, the most common stroke type, where additional early treatments are available within these first several hours. These treatments include giving the intravenous clot buster, or tPA, within four-and-a-half hours of symptom onset, and catheter-based procedures directly into the blocked vessels, usually up to eight hours from symptom onset.

Brain bleeds with ruptured blood vessels, hemorrhagic strokes, despite being less common, also have high morbidity and mortality, and early neurosurgical interventions also can lead to improved patient outcomes. Early clinical data with existing telestroke systems elsewhere reveal increased acute stroke treatment rates, particularly increased intravenous tPA use, as well as subsequent improved stroke patient outcomes, whether the patient was transferred to an academic stroke center or remained at the community-based hospital system (with guidance and support via telestroke stroke physicians and nurses). Therefore, it is critical to have access to neurology and neurosurgical stroke experts 24 hours a day, seven days a week, to provide early guidance and support to the outside hospital staff as well as help decide which patients would benefit from a hospital-to-hospital transfer for higher level of stroke care. With a telestroke network, this allows for uniform, consistent, optimal stroke care for all patients at any hospital system within the network.

Penn State Hershey Medical Center has developed the LionNet system, a partnership with regional community hospitals, which includes a telestroke program, in conjunction with REACH Call Inc. The telestroke program will begin in mid-July. LionNet’s goal is for Penn State Hershey to partner with several regional community hospitals to improve stroke care in central Pennsylvania via telemedicine. The LionNet telestroke program provides real-time, remote audio-video access to a live patient consultation by a Penn State Hershey stroke neurologist or neurosurgeon, and current actual brain or vascular imaging studies can also be reviewed. An optimal acute stroke treatment plan is formulated after this consultation. Using this technology platform, patients at nearby community hospitals now have access to the same level of stroke care and treatments, as well as potential research protocols, as if they were seen directly at Penn State Hershey. Also, many stroke patients can now remain at the outside hospital with our telestroke guidance and support, keeping them close to their families and community. With this technology, a patient’s physical location does not need to determine their level of stroke care based on the local expertise available.

The LionNet partnership encompasses more than technology and equipment. The goal is to be a true partner with other regional hospital systems and communities throughout the spectrum of stroke care -- from prevention to acute care to neurorehabilitation. An essential element of the partnership is to provide continued education and support to not only physicians and nurses, but also to pre-hospital EMS staff as well as patients and their families and the communities served by these other hospital systems. By incorporating a comprehensive, multidisciplinary treatment approach, including telestroke technology, this will hopefully result in improved patient outcomes and patient and family satisfaction throughout the spectrum of stroke care in our region.

With the LionNet network and telestroke technology, we can change the lives of our stroke patients in our region, and distance from advanced stroke expertise no longer needs to be a barrier to optimal stroke care.

Raymond J. Reichwein is an associate professor of neurology, director of the Neurology Stroke Program, co-director of the Stroke Center, director of the Penn State Hershey Rehabilitation Hospital Stroke/TBI Program and associate medical director, Penn State Milton S. Hershey Medical Center.

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Last Updated July 18, 2012