Clinical Telemedicine Blog

SOC Teleneurology Team Thanks EMS Personnel

By Amy Levitt

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It’s National EMS Week and Specialists On Call would like to take this opportunity to thank all Emergency Medical Services personnel for their vital public service and positive impact they have on the survival of anyone who experiences sudden injury or illness. We’d like to especially say thank you for their contributions to early recognition of stroke. For more than half of all stroke patients EMS is the first medical contact they have. These patients are dependent upon EMS personnel’s ability to accurately and quickly recognize the signs of stroke and get them to a neurology specialist who can prescribe life-saving treatment.

Due to the short eligibility window for administering tPA, EMS responders and SOC’s TeleNeurology service are essential to the quality of stroke care.  Since there’s almost no way for EMS personnel to know precisely when the symptoms started, it’s even more critical that they transport the patient to a hospital that can guarantee a neurologist available for consult. Specialists On Call is the largest provider of teleneurology care in the world, with over 4,000 patients treated every month and more than 200,000 consultations performed to date. In many instances, even with a 15 minute response time, we still wouldn’t have had the opportunity to see and save a patient were it not for the expertise and fast thinking of the EMS responder.

To all Emergency Medical Services personnel: thank you. We recognize and honor you during National EMS week as well as the remaining 51 weeks a year.  We look forward to continuing our collaboration in improving stroke care.

Contact us to learn more about how we can help improve stroke care in your hospital.

Topics: telemedicine, Stroke, neurology, teleneurology, emergency neurology, stroke awareness, Emergency Medicine, Neurologic Emergency, Neurologic Emergencies, SOC, emergency departments

Teleneurology Provides Rapid Response from a Top Level Neurologist

By Jeff Simer

Two weeks ago I had the pleasure of attending the Society of Interventional Radiologist CLOTS training course in Dallas TX. The course is staged as a comprehensive five-day training course is composed of in-depth multidisciplinary lectures emphasizing the entire spectrum of stroke diagnosis and management.

The conference was centered around the minimally invasive approach to advanced ischemic stroke intervention and all of the management considerations, along with this, there was a full suite training course on the various techniques and medical device technology-from imaging to the catheter based solutions to intervention.

There were many presentations at the meeting, presenting many findings from some of the luminary interventional programs in the U.S. and Europe. 

Several presentations focused specifically on the overall process in which acute ischemic stroke is identified, triaged, processed, and managed on a systemic level.  This approach is generally considered a “Hub and Spoke” a model of developing a transfer pattern with in a defined geography where institutions that do not have in-house interventional capabilities can efficiently refer the appropriate cases to the “hub” for the advanced procedure that would not be able to be performed in-house at the originating site.  This model is particularly attractive to the interventional team as the number of in-house cases that present are generally not in sufficient numbers to fully support and justify the cost burden of a full swing interventional program. 

SOC attended this course in order to bring attention to one of the key issues that hinders these programs from realizing their growth potential-Acute Emergency Neurological consultation in the ED.  All interventional programs depend on the neurology staff of any given institution to identify candidates for both IV lytics, medical management, and in most cases, those that would benefit from advanced intervention in a bi-plane suite.  Many community level hospitals do not have 24/7/365 neurology to cover ED stroke call.  Even those that do, do not have the ability to respond to stroke codes within the “window” that stroke cases require to capture the opportunity for either lytics administration or intervention.  Hence the emphasis on how to create a network of hospitals that can feed an interventional practice.  This window is often lost due to the response times from the local specialists.  The lytics window is up to 4.5 hours for IV, and 8-12 for endovascular therapy.  The SOC specialists are guaranteed to respond in 15 minutes or less, thereby shortening the time that is lost waiting for a specialist to give an opinion on the case. 

Many Interventional programs lack the depth of call and expertise to provide such rapid response to neurological emergencies in the community setting.  With that said, many of the institutions that develop partnerships as “hub and spoke” lose momentum as the neurological consulting staff is not deep enough to provide 24/7/365 call coverage in a consistent and rapid fashion-burn out ensues and the network loses its effectiveness.  As a result, many of the partners lose confidence in calling for consultation and revert back to just sending all cases to the tertiary center.  This is neither good for the patient nor the receiving hospital, as the vast majority of cases are ones that can stay at the originating hospital and need not be transferred away from the community.  The receiving hospital is then using resources to manage patients that could have been kept at the partner site and not using the resources for advanced care. 

SOC had Dr. Heather Linn present on the history of SOC, the methods and value that having the availability of rapid response from a top level neurologist.  She articulated to the audience how 15 minute response time, along with the correct information has allowed SOC doctors to deliver more front line acute stroke care than any other neurological practice in the U.S.  Because SOC physicians are all fellowship trained and also well versed on the available interventional treatments available in most tertiary centers, SOC is uniquely able to assist both hubs and partner hospitals in tending to the extremely time sensitive nature of acute ischemic and hemorrhagic strokes.  With that said, there was considerable interest from the interventional field in how SOC can partner in assisting the flow and triage of patients that are appropriate candidates for advanced neuroendovascular procedures.  The body of specialists I spoke to were blown away with the volume of cases that the SOC physician staff has responded to, on average over 10,000 a year.  Further, they were also impressed with the ability to appropriately manage and in many cases recommend treatment for these critically ill patients. 

I very much enjoyed the presentations I attended and want to thank everyone that stopped by the booth and asked questions or for more information.  It is clear that there is high value in utilizing the SOC solution as a key component in an advanced neuro-rapid response outreach program.  I look forward to seeing more partnerships with SOC as an integral part of advanced Neuroscience initiatives.

Topics: telemedicine, Stroke, neurology, teleneurology, emergency neurology, healthcare, Emergency Medicine, Neurologic Emergency, Physicians, Neurologic Emergencies, telemedicine solutions, Specialists On Call, SOC, hospitals, emergency departments, emergency department, On Call Coverage, Telepresence, Patients, telehealth, neurologists, telestroke, Efficiency, CLOTS, Society of Interventional Radiologist

World Stroke Day - Learn the Warning Signs of a Stroke

By Joe Peterson, M.D.

Warning signs of stroke1 in 6 men and 1 in 5 women will experience a stroke in their lifetime; Every two seconds, someone in the world suffers a stroke; Every six seconds, someone dies of a stroke; Every six seconds, someone’s quality of life will forever be changed – they will permanently be physically disabled due to stroke.

 

Today is World Stroke Day, a day dedicated to promoting stroke awareness.  SOC is proud to be one of the companies helping to fight this epidemic. There are 800,000 strokes a year in the USA; approximately one of every 50 is evaluated by a SOC physician.

In honor of World Stroke Day we want to remind you of the tremendous work we do made possible because of the amazing employees, partners, hospital partners, and physicians we work with. Consider that, with your help, SOC:

  • Provides 24/7/365 on-call emergency teleneurology coverage for 225+ hospitals in 23 states
  • Delivers over 2,000 emergency teleneurology consultations each month
  • Has conducted more than 55,000 emergency teleneurology consultations in less than 6 years – more than any bricks and mortar medical facility in the country
  • Delivered 13,000+ stroke consults per year
  • Oversaw the administration of t-PA 900+ YTD 2012

Knowing the warning signs and getting someone who may be suffering a stroke to the hospital quickly allows them to be assessed for the clot-busting drug t-PA, which may reduce disability or death from stroke. An easy way to recognize the sudden signs of stroke is to remember FAST:

F – Face - can the person smile?
A – Arm - Can the person raise both arms?
S – Speech - Can the person speak clearly and understand what you say?
T – Time - Act FAST!

By simply educating yourselves and your families on the signs and symptoms of stroke and seeking immediate treatment, together we can make a profound improvement in the care of stroke patients across the country!

 

        Joe Peterson, MD

JP Signature

Topics: telemedicine, Stroke, neurology, teleneurology, emergency neurology, stroke awareness, healthcare, Emergency Medicine, Neurologic Emergency, Physicians, Primary Stroke Centers, Neurologic Emergencies, World Stroke Day, telemedicine solutions, warning signs of stroke, FAST test for stroke, Specialists On Call, SOC

Telemedicine Made Personal

By Amy Levitt

Most televised reunions are gimmicky and superficial, but there was nothing trivial about the reunion of Sandra Bowden and Todd Samuels, M.D., at this year’s American Telemedicine Association (ATA) annual meeting in Tampa.

What the “Human Touch of Telemedicine” conference video crew captured that day was a vision of our medical future: a teleneurology advocate and stroke patient from Texarkana, Texas, getting to meet the neurologist who assessed her from his office in Baltimore, Maryland—and helped improve her outcome and recovery time. Here, in her own words, is Sandra Bowden’s account of her very personal introduction to the benefits of teleneurology.

Telemedicine Made Personal

There are many ironic moments in life, but few that compare to my stroke assessment last year.

I am director of medical post-surgical services at Christus St. Michael Health System in Texarkana, Texas—a city perhaps best known for being the hometown of one-time presidential candidate Ross Perot. Although our facility includes a 312-bed acute care hospital, Texarkana is still a fairly small city—ranking 288th in the latest U.S. census. We don’t have as many local neurologists to call as do hospitals in Boston or Los Angeles. For that reason, teleneurology has played a key role in our hospital’s campaign to become a certified stroke center.

In 2010, during an early morning meeting with the Christus stroke team, I began to feel a tingling sensation in my ear and face. It spread down my left arm, and a colleague noticed that the left side of my face was starting to droop. She quickly escorted me to the ER, where the doctor ordered a CT scan. By the time I returned to the ER, Specialists On Call, our recently implemented teleneurology provider, had been notified and neurologist Todd Samuels was speaking with my physician.

With the help of the attending nurse, Dr. Samuels began a complete neurological assessment. Throughout the entire consultation, I was the center of his attention. He answered all the questions my husband and I had, and made us both feel comfortable during a very difficult time.

Dr. Samuels told me that he believed I was having a stroke that would respond well to the clot-busting drug called tPA. He also explained the risks and benefits of the therapy. I assumed he would order the drug and be done, but he stayed and checked in on me. In a short time, I started having resolution of my symptoms—and Dr. Samuels seemed very pleased with the outcome.

I was soon transferred to the ICU, where my condition steadily improved. The left side of my face continued to droop for a few days, and I had some minor issues with gait and balance. But physical therapy resolved those conditions, and today I live a normal life with no deficits.

So when I attended the ATA annual meeting earlier this year, I had no idea that I would be meeting Dr. Samuels in person. It was a complete surprise to me. I knew I’d never forget his face, and it was wonderful to express in person how grateful I was. I couldn’t have asked for higher quality care.

I have long been a teleneurology advocate, but it wasn’t until I was the recipient of this innovative approach to care that I completely understood its importance. This is the way that medicine is going. We already have far too few specialists to meet the growing needs of people in areas of the country like mine. But I’ve experienced first-hand how teleneurology can help solve the specialist shortage and offer wonderful, life-saving care. After my encounter with SOC, I more firmly than ever see telemedicine as the wave of the future.

--Sandra Bowden, RN-BC, MSN

Topics: telemedicine, Stroke, neurology, teleneurology, emergency neurology, hospitals, telestroke, Uncategorized