"Time is brain." This phrase has been made increasingly famous in the world of medicine in the past 20 years. In the field of stroke care, every second counts in trying to return blood flow to the brain. In fact, it is estimated about 1.9 million neurons die with every minute of untreated stroke.
Treatment of stroke has progressed from giving clot-busting medications such as alteplase guided by a neurologist to mechanical retrieval of the clots of by an experienced interventionalist. The clinical decision and timing are both key in decreasing disability and death from stroke worldwide. While many hospitals have around-the-clock stroke expertise, even more do not. This gap has been filled with great success by telestroke and teleneurology.
Telestroke has become increasingly common, and roughly 30 percent of all emergency rooms in the U.S. now use telestroke technology. The many benefits of telestroke have been published in major journals. Patients who present to hospitals with telestroke capacity were more likely to receive acute stroke treatment and have lower death rates, with the most effect in rural and community hospitals.
Telestroke consultation is a real-time video conference with the patient, the remotely-located stroke specialist, and a bedside health care professional in the emergency room. A remote stroke neurologist will interview and examine the patient, review imaging and determine candidacy for clot-busting medication and/or clot retrieval. The stroke neurologist will also guide needs for transferring to a comprehensive stroke center and other treatments, such as stroke prevention.
Not only are the telestroke providers guiding acute stroke treatments, but they are also working with staff and administration to improve stroke awareness and education. This extends beyond the emergency room setting to daily teleneurology rounding on patients in the hospital who require neurological care. This cooperation has led to significant improvement in stroke evaluation, treatment times and — ultimately and most importantly — patient outcomes.
Since late 2019, SSM Health St. Mary's Hospital has been working with Sevaro, a telehealth company that specializes in acute stroke care as well as general neurology. For St. Mary's, the improvement in neurology and stroke care has been dramatic.
For example, a recent stroke patient was assessed by EMS on the way to the hospital. EMS provided a clear and detailed report of the patient's condition resulting in the activation of a pre-hospital Code Stroke. A team assembled and waited for the patient to arrive. Due to the detailed EMS report, the telestroke provider and the emergency room physician collaborated to make a quick and effective treatment decision prior to the patient's arrival. The patient was given alteplase, which is a medication to break up the clot that is causing the stroke, within 20 minutes of arriving at the hospital. The goal is to give this medication within 45 minutes of arrival to the hospital. The teamwork and collaboration of EMS and the Code Stroke team including telestroke resulted in a positive patient outcome and a significant improvement in symptoms.
These and countless other examples would not be possible without the quick access to stroke experts available through telestroke/teleneurology. Telestroke technology has made a huge impact on hospitals across the nation.
May is National Stroke Awareness Month. SSM Health St. Mary's Hospital has partnered with the American Heart Association to host a virtual lunch and learn at noon Wednesday. Several experts will discuss the latest advances in diagnosing and treating stroke patients as well as risk factors and preventative measures you can take to lessen your chances of experiencing a stroke. You can register for the event on the American Heart Association — Missouri Facebook page.
Dr. Mike Chen is a board-certified neurologist specializing in stroke and vascular neurology. As the regional stroke director for Sevaro Health, he provides hospitals such as SSM Health St. Mary's Hospital with teleneurology and telestroke services. He currently lives in Seattle, Washington.