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Different Strokes

New technology is changing how stroke patients are treated – and speeding up recovery.

Different Strokes
By Donna Burch

Midlothian resident Glenn German has beaten the odds. He’s fully recovered after having a stroke last fall – putting him into a category with little company. Only 10 percent of those who suffer a stroke completely recuperate with no long-term effects.

German’s recovery is at least partially credited to Bon Secours Richmond Health System’s use of teleneurology, which involves utilizing video conferencing to perform neurology exams to diagnose and treat potential stroke patients. Bon Secours began using teleneurology several years ago and recently fine-tuned its protocols by upgrading its equipment and contracting with a new teleneurology practice in Atlanta, Georgia.

When German arrived at St. Francis Medical Center last October, he was immediately given a CT scan to check for brain clots and then ushered into the emergency room for a consult with a neurologist. Only, the neurologist was more than 200 miles away in New Jersey.
“[The neurologist] was dressed in civilian clothes, and it appears as though he was in the library or the study of his home,” recalls German, 75. “There was a TV at the end of the [hospital] bed, and I could see him, and he could see me. It was almost like having a doctor right there, telling the staff what to do.”

Just a few minutes earlier, German had been at home. It was seemingly an ordinary day until his phone rang, and he opened his mouth to answer.

“All of a sudden, I was not making any sense,” he says. “[My wife Betty] took the phone away. I was processing everything, but I was speaking gibberish.”

A retired nurse, Betty immediately recognized her husband was having a stroke and called for an ambulance. On the way to St. Francis, paramedics notified the hospital that German was probably having a stroke. That call initiated the hospital’s stroke protocol, signaling emergency-room staff, CT technicians and lab techs to prepare for German’s arrival.

German’s teleneurologist was available for a consultation within minutes.

While most medical centers still use on-staff neurologists, teleneurology offers several advantages – chief among them is the ability to diagnose and treat stroke much faster than traditional methods. It eliminates the time it takes for an on-staff doctor to get in his or her vehicle, drive to the hospital, park and make his or her way to the emergency room. Shaving off just a few minutes can make the difference between a patient who fully recovers and one who doesn’t.

“What the hospitals need is someone who can come right away,” says Dr. Matthews Gwynn, chief executive of AcuteCare, the Atlanta-based teleneurology practice that now contracts with Bon Secours Richmond. “We can be in Richmond; we can be in Macon, Georgia; we can be in South Carolina. We can be anywhere at any given time. … It’s much faster for the patients.”

Shortly after his stroke diagnosis, German was given tPA (tissue plasminogen activator), a clot-busting medication that has to be administered within three hours of the beginning of a stroke in order to be effective. Within 20 minutes of receiving the medication, German regained his speech and his stroke was over.

German’s medical care was transferred to an on-staff neurologist at St. Francis. He was released from the hospital two days later and has suffered no lasting effects from his stroke.

“[My doctor] indicated I’m no more prone to expect another stroke than the odds were on the first one,” German says.

But not every stroke patient is so lucky. According to the Centers for Disease Control and Prevention, almost 130,000 Americans die from strokes each year. More than 795,000 people in the United States suffer from strokes annually. Of those, 40 percent experience moderate to severe impairments requiring extensive follow-up care.

“Every minute delay in treating a stroke, you lose 2 billion brain cells,” says Dr. Stacey Epps, executive medical director of the Bon Secours Virginia Neuroscience Institute. “Studies have shown the earlier patients get [tPA], the more effective it is. For every 15 minutes you wait or delay in giving tPA, there’s increased risk of disability.”

Long-term effects of stroke can include paralysis, difficulty with speech and language, difficulty swallowing and memory loss.

“The disability in some people can be worse than if they died,” Epps says. “The longer you delay treatment, the more likely you are to have disability.”

AcuteCare began offering teleneurology at all of Bon Secours Richmond’s hospitals in March. The average response time for a consult is just under 2 minutes.

(Previously, Bon Secours Richmond contracted with another teleneurology practice.)

“One reason that hospitals really like us is their rate of giving tPA triples generally,” Gwynn says. “Most of our hospitals were giving tPA to about 4 percent to 5 percent of eligible patients [prior to using AcuteCare for teleneurology consults]. We’ve more than tripled that [rate].”
AcuteCare offers teleneurology services in 28 hospitals in six states.

In addition to its new partnership with AcuteCare, Bon Secours Richmond recently updated its video conferencing abilities by investing in new telemedicine-friendly robots. Stethoscopes and other diagnostic tools can be attached to the robots, enabling telemedicine physicians to conduct exams just like in-person doctors. The screen resolution is so clear that physicians hundreds of miles away can actually assess a patient’s pupil response.

Bon Secours Richmond’s partnership with AcuteCare and the new robots take the health system’s stroke care “to the next level,” Epps says. “We’ve found that by using the teleneurology system, we were able to give faster care to patients to increase the quality of the care we gave. … Our data shows our patients are having better outcomes. We’re seeing people get complete recoveries and more people going home [instead of to a nursing home for long-term care].”

Would you recognize a stroke?

The acronym “BE FAST” will help you identify if you or someone close to you is having a stroke:

B = Balance issues
E = Eye problems
(going blind in one eye, missing or blurred vision)
F = Face drooping, numbness or tingling
A = Arm weakness or leg numbness on one side of the body
S = Speech difficulty
(slurred or garbled language)
T = Time to call 911

Stroke symptoms vary and all of the symptoms mentioned above are not present in every patient.

© 2017 Chesterfield Observer