Telemedicine Brings Specialty Care To Stroke Patients At Falmouth Hospital
By: ANDREA F. CARTER, August 19, 2014
In June Falmouth Hospital earned the American Heart Association/Stroke Association’s Get With the Guidelines Stroke Plus Quality Achievement Award for its overall stroke care for the third year in a row.
Central to the program is the hospital’s participation in the Partners TeleStroke network, which uses telemedicine to link to stroke specialists at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston to provide timely care to acute stroke patients here in Falmouth.
For patients with an ischemic stroke, caused by a blocked blood vessel in the brain, time is of the essence for treatment.
“Time is brain,” said registered nurse Jean Estes, stroke nurse coordinator at Falmouth Hospital. “32,000 brain cells die each second after a stroke.”
Specifically, patients need to be evaluated quickly to see if they are eligible to receive the drug t-PA, a tissue plasminogen activator, which is given intravenously and helps dissolve blood clots involved in the blockage.
“There is a golden hour to receive t-PA after patients come into the door,” Ms. Estes said.
This treatment, however, has risks as well. It can cause more bleeding, breaking down the blood vessel and causing more damage to the stroke site. Out of 100 people receiving the drug, 94 will have some or no improvement, six will become worse and for three of those six the drug could prove fatal.
“Because of this risk we want to be careful,” Dr. Michael T. Leahy, director of the stroke program at Falmouth Hospital, said. “It’s time dependent. In any patient after four and a half hours it can do more harm than good.”
The symptoms of a stroke are varied and often difficult to detect. They often come on suddenly and can include headache, vertigo, loss of vision or confusion. Ms. Estes uses the phrase “think FAST”—standing for face drooping, arms that become weak or numb, slurred speech, and time of response being critical—in educating the community about stroke signs at health fairs and other community venues. The American Stroke Association says that 795,000 people suffer from a stroke each year. Strokes can be fatal or lead to long-term disabilities such as paralysis.
The same recommendations to prevent heart disease, a good diet, no smoking and exercise, apply to stroke prevention as well.
“In many ways it’s the same disease,” Dr. Leahy said. “It’s still a blockage of arteries.”
Both Dr. Leahy and Ms. Estes credit the EMTs and ER staff as the first response to alert the hospital to stroke patients coming in and the time the stroke occurred. Upon arriving at the hospital patients receive a computerized tomography, or CT, scan. If there is already significant bleeding the patient is not a good candidate for the treatment.
Next, staff call the TeleStroke doctors in Boston for a consultation; that team calls back within five minutes, Ms. Estes said. Then Ms. Estes or a nurse plug in a monitor screen and an Internet connection linking them to stroke neurologists in Boston, who can do an examination of the patient by camera. Family members are also often present. Patients are moved up to Boston after they receive the t-PA.
Some patients and medical staff can be skeptical of the benefits of using telemedicine at first. Ms. Estes said she will often encourage patients by saying that she is going to make them a movie star as she sets up the monitor.
“I was at first apprehensive of the television and camera,” Dr. Robert J. Davis, director of Emergency Services at Falmouth Hospital, said. “But now we have this streamlined and are an example for other small hospitals.”
Falmouth Hospital offers TeleStroke services on a 24-hour basis while Cape Cod Hospital, who also received recognition from the American Heart and Stroke Association, runs the TeleStroke program during set hours but always has a neurologist on call.