NORWALK, CT - When someone has a stroke, minutes count, and delivering treatment as fast as possible is critical to preventing severe brain damage and death. That’s why Norwalk Hospital — a nationally accredited Primary Stroke Center — recently launched a telestroke program. With telestroke, neurologists can remotely consult with emergency medicine clinicians to evaluate patients, rapidly diagnose stroke, and order treatment.
Stroke, the fifth leading cause of death in the United States, is a broad term that describes damage to the brain. A stroke can cause lasting brain damage, long-term disability, or even death. There are two types of stroke: hemorrhagic stroke which results from bleeding inside the brain, and ischemic stroke which occurs when a blood clot blocks the oxygen-rich blood supply to the brain. Ischemic stroke occurs in about 87 percent of stroke cases. A clot-busting medicine called tissue plasminogen activator (tPA) is the standard treatment for ischemic stroke.
The Norwalk Hospital Emergency Department (ED) staff and the stroke rapid response team, which includes a neurologist, follow standard protocols for all patients who come to the ED with stroke symptoms. If they suspect a stroke, the ED physician and neurologist will evaluate the patient, and determine if tPA is the best course of treatment.
As a stroke can occur at any time, day or night, a neurologist may not be at the hospital when a suspected stroke patient enters the ED. In these cases, the ED physician or nurse that evaluates the stroke patient contacts the on-call neurologist and they then drive to the hospital.
Advanced Telestroke Technology
Norwalk Hospital’s telestroke program expedites the stroke evaluation from the neurologist. The ED doctor or nurse remote-connects the patient to the neurologist using a mobile telemedicine cart with audio and video capabilities. The neurologist can then speak with the patient and accurately visually and physically (with the assistance of a bedside nurse) assess the patient from top to bottom by controlling the camera remotely. The neurologist then determines whether tPA is an appropriate treatment and communicates this to the ED physician.
Studies have demonstrated that telestroke is equally as safe as a live consultation. The Health Insurance Portability and Accountability Act (HIPAA)-compliant telestroke system does not store any audio or video related to the consultation.
Depending on the case, the neurologist will still go to the hospital to examine and consult on the patient in-person. But the telestroke conference enables the neurologist to deliver a time-sensitive treatment much more quickly.
“Stroke is an emergency situation where time is critical. The faster a patient is treated for stroke, the greater the chance to preserve as much brain function as possible,” said Benjamin Greenblatt, MD, chair of emergency medicine at Norwalk Hospital. “While we consistently provide safe, timely care to our stroke patients, we identified a way to deliver effective treatment even faster.”
Telestroke is a clear example of using technology to optimize patient care.
“I’m excited about how telestroke will help our stroke patients have the best possible outcome so they can maintain their independence and quality of life,” said Dr. Greenblatt.
Revolutionizing Stroke Care
Telestroke has been revolutionary for patients who live in rural areas, where there may not be any neurologists (or other kinds of specialists) nearby. Although Norwalk Hospital is in an urban area, the hospital saw a need for telestroke because traffic on the highway can slow down neurologists in route to the hospital.
“Telestroke at Norwalk Hospital is a necessary step given that Fairfield County is prone to traffic congestion,” said Daryl Story, MD, neurologist and director of the Acute Stroke Team at Norwalk Hospital. “Norwalk Hospital is committed to providing the best stroke treatment available. The telestroke program will enable us to provide more rapid treatment in a time-sensitive emergency situation.”
When it comes to stroke care, “time lost is brain lost.” The longer a stroke goes untreated, the longer the brain is deprived of oxygen. Additionally, in order to be the most effective and reduce the risk of complications from the medication, tPA must be delivered within four and a half hours of when the patient begins to show stroke symptoms. Telestroke could make all the difference in whether tPA is a viable treatment.
Michele Lecardo, MSN, RN, CCRN, CNL, SCRN, stroke program coordinator at Norwalk Hospital, said on-call neurologists arrive to the hospital as quickly as possible, but when minutes count, the team wanted a way to ensure the quickest response time.
Developing the Norwalk Hospital telestroke program was a team effort that involved coordination of many different departments and specialties.
“Clinicians, administrators, compliance, and IT — including clinical informatics analysts, security, and telecommunications — worked together with the common goal to provide exceptional stroke care for all Norwalk Hospital patients,” said Deb Picchione, MS, BSN, RN-BC, clinical informatics analyst for Western Connecticut Medical Group. Deb was part of the steering committee that spearheaded the telestroke program.
Use B.E.F.A.S.T. to Evaluate Stroke Symptoms
While telestroke can expedite treatment for stroke, it is also still important that someone go to the hospital as soon as stroke symptoms emerge.
To help identify stroke symptoms, remember the acronym B.E.F.A.S.T.:
B: Balance — sudden dizziness, loss of balance, or coordination
E: Eyes — sudden trouble seeing out of one or both eyes
F: Face — facial weakness, uneven smile
A: Arm — weakness, unable to raise one or both arms
S: Speech — impaired, slurred, difficulty repeating simple phrases
T: Treat — seek treatment immediately!
If you are experiencing any signs of stroke, call 9-1-1 immediately. Emergency service personnel are trained to recognize the signs of stroke, and will take you to the right hospital to treat your stroke. For instance, Norwalk Hospital has a rapid response team that is alerted and ready to treat stroke patients upon arrival at the hospital.
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