Published On September 26, 2014
THERE’S NO MYSTERY ABOUT HOW TO HELP PATIENTS who may be having stroke. Get them to a hospital, determine whether they’re candidates for tissue plasminogen activator, or tPA, which can help dissolve stroke-causing blood clots, and administer the drug to those who qualify as soon as possible and within three to four hours of when they were last in their usual state of health. Waiting longer is less effective and brings a risk of brain hemorrhaging. But smaller hospitals without a neurologist on staff usually won’t use the drug, and relatively few patients get tPA. A large study of nearly 1,700 hospitals published last year showed that while twice as many patients received it in 2011 as in 2003, more than 90% who’d had a stroke still didn’t get the treatment.
In contrast, at hospitals in the Partners TeleStroke Alliance Program—for which Massachusetts General and Brigham and Women’s hospitals in Boston serve as “hubs,” providing around-the-clock consultations and expertise to 30 smaller regional “spoke” facilities—20% to 30% of patients get tPA within the recommended time window. The connections to the city hospitals effectively convert the outlying facilities into high-performance stroke centers.
MGH helped develop the telestroke approach, beginning in 2000 with a pilot involving a small hospital on Martha’s Vineyard, a coastal island almost 100 miles away. Using a private high-speed broadband network and two-way videoconferencing, the experiment enabled an MGH neurologist to talk with and examine stroke patients and make recommendations to their physicans at the island hospital. Today, doctors or patients at spoke hospitals can connect with MGH experts using cost-effective technologies that continue to get less expensive. “That has alleviated the technology burden on telestroke networks and it lowers the entry bar for a spoke hospital,” says Juan Estrada, MGH Telestroke program manager.
In a recent survey of Partners TeleStroke patients, 85% considered their long-distance interactions with doctors comparable to face-to-face encounters. “You might think patients would come into the emergency room and think, ‘Why am I getting a doctor on a television screen?’” says Lee Schwamm, MGH executive vice chair of neurology and medical director of MGH TeleHealth, who helped launch the telestroke program. “That hasn’t been our experience at all.”
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