A neurologist in Spokane instantly can be at the hospital bedside of a stroke patient 35 miles away, thanks to a remote robot, when minutes count for saving lives or increasing chances of recovery without permanent disabilities.
Providence Sacred Heart Medical Center & Children's Hospital recently launched what's called the telestroke network, after providing training and a robot in late January at Lincoln Hospital in Davenport, Wash., to assist with evaluations of stroke patients there.
Sometimes called brain attacks, strokes occur when a blood vessel carrying oxygen and nutrients to part of the brain is either blocked by a clot or breaks, and brain cells die, the American Stroke Association says.
By late May, Sacred Heart expects additional telestroke robots to be online at four medical centers around the state, including Pasco-based Lourdes Medical Center, Kennewick General Hospital, Quincy Valley Medical Center, and Tri-State Memorial Hospital, in Clarkston. Robots for Newport Hospital and Whitman Hospital, in Colfax, could be ready by June.
Through the network, a patient and health care provider in the remote facility can hear and see a Spokane-based neurologist, whose face appears on the robot's monitor screen. Using a computer and wireless technology, the neurologist can manipulate movement and tools of the 5-foot-6 inch robot remotely, which include its camera and 360-degree infrared sensors to view vital signs and charts.
The earlier that stroke victims can be evaluated and receive treatment, the better typically for their recovery results, says Dr. Ben Atkinson, a Sacred Heart neurologist. He says the robotic network allows him within minutes of logging onto a computer to evaluate a patient using the National Institutes of Health Stroke Scale, a standardized way to quantify impairment caused by stroke and the stroke's severity.
Ischemic strokes, the most common type of strokes, can be treated with a drug called t-PA, which dissolves blood clots obstructing blood flow to the brain. With the network, Atkinson says he also can view magnetic-resonance imaging of the brain. Physicians use the NIH Stroke Scale to measure any neurological deficits by asking the patient to answer questions and to perform several physical and mental tests.
"I can be with a patient within a minute and evaluate the patient almost as if I'm there to determine whether to give t-PA medication," Atkinson says. He typically also is talking to a health care professional who is with the patient.
Atkinson adds, "We used to do this over the phone. I can see what's happening during the physical exam. The optics are good enough for me to zoom in and I can see the pupil of their eyes."
In the U.S., more than 790,000 strokes occur each year, and stroke is the fourth leading cause of death in the country.
The National Institute of Neurological Disorders and Stroke, a research institute of the NIH, suggests that patients get to the hospital within 60 minutes of a stroke to allow time for an evaluation, and says treatment should commence within three hours of a stroke. The research institute also says that every minute counts when someone is having a stroke, and that the longer blood flow is cut off to an area of the brain, the greater the damage, which might include long-term disabilities.
The research center also says that in a five-year study it conducted, some stroke patients who received t-PA within three hours of the start of stroke symptoms were at least 30 percent more likely to recover with little or no disability after three months.
In February, Providence Holy Family Hospital, on Spokane's North Side, became the second location in the Spokane area to receive a telestroke robot.
Sacred Heart leases the telestroke equipment from Santa Barbara, Calif.-based manufacturer InTouch Health, at a cost of about $2,200 to $3,800 per robot a month, depending on the model of the robot and its features, says Tena Cramer, director of Sacred Heart's neuroscience service line program. That covers technical support as well, she says.
The outlying hospitals don't pay to be part of the robotic network, she adds, and the hospitals bill the patients' insurance provider for the neurologist's consultation. Sacred Heart typically places the robots in the emergency rooms of the remote hospitals, but the units easily can be moved into patient rooms or other parts of a medical center, Cramer says.
She says one of seven neurologists at Sacred Heart is always on call, so the telestroke network can provide timely evaluations of stroke victims at those outlying hospitals that don't have neurologists in their communities.
Atkinson adds that whenever possible, it's better for stroke patients to remain in their community medical centers closer to family support, rather than to be transported or make the drive into Spokane. However, after completing an evaluation, the neurologist also might determine that a patient needs to be transported to Spokane, he says.
"The stroke scale score helps us determine the severity of the stroke," he adds. "In a few cases, the score may determine a severity that requires surgery. If we need to remove a clot or do interventional therapy, then we'd transfer them here."
Signs that someone is having a stroke include trouble walking, weakness on one side, and difficulty seeing and speaking. As an example of a step in the stroke evaluation, Atkinson says he can ask the patient to smile, while he zooms the camera in closer to the patient's face to assess facial symmetry.
The robotic equipment also includes the ability to hook up a stethoscope that the neurologist can listen to remotely.
Atkinson says that if he's away from Sacred Heart and its robotic network control station based there, he can log into the network by using a laptop computer, or an iPad. He says he recently was able to provide a telestroke network consultation while he was away from Spokane at a medical conference in Seattle.
"Usually, the process is that the outside hospital calls our transfer center," he says. "The physician gives us the basic information. I tell the physician I'm going to be logging in, and then I'll pop up on the screen."
He adds, "At Lincoln, the last time I worked with a nurse practitioner. Some hospitals are so small, they may not have a physician available. It could be anyone on site from an ER doctor to a nurse practitioner or physician's assistant."
As of mid-April, Cramer says two patients have received neurologists' evaluations through the new telestroke network. She says the volume of use will likely rise as more outlying communities start using the network, and as more people living in the communities learn to recognize symptoms of stroke earlier.
Atkinson adds that the robotic network also can be used for patients' follow-up appointments and for acute neurology evaluations.
"We want to provide neurologists' expertise while doing what we can to keep patients at their facilities if possible," he says. "It serves two purposes, it supports the small hospitals if patients can stay there, and it helps the patient as they recover to have the support of family members who aren't worrying about the logistical problem of traveling to Spokane."
Atkinson adds, "We feel we're just beginning. I've done some general neurological ICU consults, instead of someone driving an hour to get here, we can provide these services. We'd like to open that up to other specialists as well."
Cramer adds that additional future uses for the robotic network will be based on the needs of the outlying medical centers that often don't have access to highly specialized physicians. In Davenport, Lincoln Hospital serves a population of about 10,000 people.
"It's difficult even for a hospital of our size to recruit all the specialists we need, because there are so few of them," she says. "It's even harder for rural, smaller hospitals."
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