By Lisa Shrewsberry
“Time saved is brain saved,” said Dr. Michael Dobbs, director of the Stroke Care Network and interim Neurology chair at the University of Kentucky, who met Wednesday for the third time with a group of physicians and administrators from Beckley Appalachian Regional Hospital before their “go live” moment with the new UK stroke hotline, a representation of technology combining with expertise to improve patient outcomes.
“It’s important to make quick, informed decisions about giving intravenous clot-busting drugs in emergency rooms, and having telephonic access to skilled stroke neurologists helps to make the difference in critical decision-making,” stated Dobbs.
Beckley ARH Medical Director Dr. Jim Kyle explained the signature UK-blue phone handset now in the ER connects directly to a specialist for real-time consultation with instantaneously transferred patient information.
“Now, for every stroke patient, Emergency Medical Services will call ahead with a stroke alert. These patients will bypass registrations and go straight to the CT scanner and into a stroke room where telemedicine begins,” Kyle described.
A stroke neurologist, those Kyle defines as ones who “eat, breathe and do nothing but take care of stroke patients every day,” will collaborate with the ER staff at B-ARH on what to do with the patients presenting with stroke symptoms. At the same time the Beckley ARH ER staff will be attending the patient, the neurologist will evaluate the electronically transferred imaging and lab information for the patient and make recommendations.
For patients experiencing ischemic stroke, sudden blockage of cerebral blood supply by a clot, this may mean being transported to the nearest facility for a direct infusion catheter procedure to the brain. The site-specific method, explains Kyle, expands the therapeutic window by three to five additional hours for intervention to rescue patients from the serious long-term effects of stroke. Intravenous thrombolytics must be administered within three hours of the onset of stroke symptoms to be effective.
The window is six to eight hours for delivery of blood thinners via catheter to the brain. This is especially important for stroke sufferers who may have had the stroke during sleep, only to wake up with the explicit symptoms the next morning, explained Kyle. Before, these and many more patients would have been considered beyond the reach of symptom-reversing thrombolytic agents.
The ideal patient for infusion catheterization is the patient who is otherwise healthy enough to handle the procedure (“it’s brain surgery within the arteries” explains Dobbs), who has a cerebral artery that is blocked and can be reached by the catheter, whose symptoms are severe enough that the intervention is worth the risk and who can receive the intervention within eight hours from the time last seen at their normal level of function.
Qualifying patients will then be transported to the closest available facility for the procedure, which in most southern West Virginia cases is Charleston Area Medical Center. Even if the patient isn’t a candidate for clot-busting drugs or catheter intervention, says Dobbs, “there is still often a lot we can do for them.”
Of his most recent visit to Beckley to initiate the program, Dobbs stated, “The stroke neurologists depend on emergency physicians on the ground to do an accurate assessment of the patient and be able to communicate it effectively. To maximize success requires up-front investment in education and relationship building. Stroke neurologists travel to the network hospital and teach emergency physicians there about acute stroke care, so that mutual trust is already built when phone calls are made.”
Rocco Massey, Beckley ARH CEO, is enthusiastic about the recent partnership with UK.
“We like to develop relationships with medical facilities and educational institutions in close proximity that will benefit the health of our patients.
“In instances where time is critical, like with heart attack and stroke, if you can have two physicians agreeing on a plan of action, that is gold standard care.”
Massey adds that, while planning has occurred over the course of the last two years, the planning group pushed for the project’s activation to coincide with the opening of the National Scout Jamboree.
“The added resource is important to our ER at a time when we could be expecting as many as 80 or more visits a day, considering the traffic expected to come along with the Scouts.”
Kyle adds that their most recent partnership is a model of what is possible through technology, what can be tremendously advantageous to smaller hospitals in the state.
“Telemedicine is a hot topic right now and the ability to have specialists on call in real time can make a big difference in quality outcomes.”