How telehealth saved a rural stroke patient

October 2, 2017

Dennis Bippes and his wife, Christine, woke up to the sound of their coffee maker, as they usually do. Soon, Dennis saw something that he didn’t expect but definitely recognized: the signs of stroke. As Christine was making the bed, she stared blankly into the middle of the room. “I asked her if she was OK,” he recalls, “and slurred words came out.” Dennis dialed 911.

The Bippeses live on a ranch nearly 100 miles outside of Spokane, Wash. En route to the closest general hospital, the ambulance crew called in to describe Christine’s condition. The call allowed the emergency department director to initiate the hospital’s stroke protocol. This included a call to neurologist Cynthia Murphy, M.D., at Providence Sacred Heart Medical Center in Spokane. When the ambulance rolled in, the team was in place.

Stroke expertise, remotely

After Christine was brought into the rural hospital's emergency department, Dr. Murphy 'beamed in' from Spokane to the bedside via telestroke - a video link on her computer.

By the time Christine was brought into the emergency department, Dr. Murphy had already spoken with the director about Christine’s symptoms over the phone. She then “beamed in” from Spokane to the Christine’s bedside via telestroke, a video link on her computer.

“I can lay eyes on the patient and observe speech, noting any aphasia (inability to communicate) or facial droop, and assign a number on the stroke scale,” she said.

A computed tomography (CT) scan was performed and the result was posted for Dr. Murphy and the caregivers at Christine’s bedside to examine. Connected via the technology, the doctors were able to see the images on their computer screens in real time. The scan ruled out bleeding as the cause for Christine’s stroke, but that wasn’t the whole story: there was a blocked blood vessel.

The decision was made to administer tissue plasminogen activator, or tPA, to minimize further damage to the brain. The drug tPA works by dissolving clots and improving blood flow to the deprived part of the brain, saving brain cells. But tPA is most effective when given within three hours of having a stroke.

Treating acute stroke patients can be challenging and requires a fast and efficient team response. Partnering with a stroke expert via telemedicine allows hospitals with limited access to subspecialists to bring this expertise to the bedside.

With Dr. Murphy coordinating her care in Spokane in advance of her arrival, Christine was flown by helicopter to Providence Sacred Heart and in surgery 45 minutes after receiving tPA. She underwent an endovascular procedure to remove the clot and later that afternoon was resting with her family around her, on her way to recovery.

Telehealth: An essential part of care

The telestroke program that made it possible for Christine to receive immediate stroke care is a clinical service empowered by technology from the Providence St. Joseph Health digital team. The first service launched in 2004 and now there are more than 35 telehealth services offered and 80 partnering clinics and hospitals. That means dozens of facilities in partnership with Providence use one or more telehealth services to provide a second layer of optimal patient care and safety around-the-clock.

By working with partnering facilities, many of them in rural communities, Providence helps patients where specialists are often in short supply and medical facilities are few and far between. It also gives patients the chance to stay close to home – in their communities and near their families – during a health crisis.

Telehealth programs help fill the care gap in rural communities by supporting bedside staff through audio and video technology. The services are not intended to replace hands-on care, but instead, to provide an additional communication tool for medical staff via real-time technology.

Archit Bhatt, M.D., a neurologist with Providence Brain and Spine Institute in Portland and medical director of telestroke services, says the service is now essential for providing optimal stroke care. “You really need to have it [telestroke program] as part of the system of care; especially in small hospitals.”

Telecritical care ideal for remote clinics

Another example of how telehealth helps rural communities is the telecritical care program, which has proven to be a helpful tool for clinics in remote regions of Alaska where resources are limited. In 2016, Providence Alaska Medical Center in Anchorage partnered with a small clinic on remote Unalaska Island to assist with medical emergencies using telecritical care. The island is home to one of the busiest commercial fishing ports in the United States.

Using satellite and other technology similar to the telestroke program, a doctor in Anchorage can review patient X-rays and other pertinent information during a medical emergency, and help determine the best course of treatment. The clinic can also use the service to help with triage during a significant event. On Unalaska Island, those events often involve sinking ships.

Proactive care: TeleICU and telehospitalist

Patients lying in a bed in an intensive care unit are under the watchful eyes of ICU staff. With similar video-enabled camera observation and a monitoring system through teleICU, patients in rural as well as urban hospitals are ensured a second layer of care and safety. Trained intensivists and nurses monitor ICU patients around-the-clock from a remote location. They also provide support during procedures and are available to answer nurses’ questions.

The “extra eyes” on the patients, as well as monitoring EKG, blood pressure and other vital signs, allow the local staff to focus on bedside care and interaction with the patients. In other words, nurses and technicians are better able to be proactive – managing a condition before it happens – rather than reacting to an adverse situation.

A similar program offers immediate, 24-hour access to hospitalists (physicians) via videoconference technology when there may not be a physician onsite. The program supports rural hospitals at night when staffing tends to be lighter. For patients who enter the ED or clinic in the wee hours, having a timely interaction with a physician can minimize the wait time between diagnosis of an injury or ailment and receiving treatment. An immediate conversation with a doctor also can relieve stress and anxiety for patients and their families.

Remarkable recovery

Christine Bippe’s stroke occurred in the language center of her brain, affecting her ability to choose and say words or phrases. But after 14 months of speech therapy, she improved by 90 percent. Christine no longer needs therapy, and only sees her cardiologist on occasion. In fact, her recovery has been so successful, she was approved to have a second knee surgery. “Everything has worked out so well considering we live way out in the forest,” she said.

New patient care approaches enabled by technology like the telehealth services shepherded by the Providence St. Joseph Health digital team are making a difference to patients like Christine. When time is the enemy during an acute health crisis such as stroke, these innovative channels of communication can greatly improve the outcome for patients who live in small, rural communities.

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