Leading Specialists Assess Patients Through Videoconference
Stroke is the leading cause of disability and the fifth leading cause of death in the U.S. according to the American Stroke Association. When a patient is having a stroke, every minute counts. Thanks to advances in technology, patients with stroke symptoms can now be rapidly assessed by a neurologist 24/7, even if the specialist is physically located many miles away.
Stroke: The First Symptoms to Note
There are two types of stroke. An ischemic stroke, the more common of the two types, occurs when an artery is blocked. A hemorrhagic stroke occurs when a blood vessel ruptures or leaks. Both types inhibit blood flow to the brain, which deprives brain cells of oxygen and can result in permanent damage.
“Both of these types of strokes are treatable, but treatments are different, and very time sensitive,” says Fan Z. Caprio, MD, a Northwestern Medicine neurologist.
Each moment counts, so F.A.S.T. is an acronym to help people detect stroke rapidly. It stands for:
- F: Face Drooping. Does one side of the face droop or is it numb? Ask the person to smile and note if the smile is uneven.
- A: Arm Weakness. Is one arm weak or numb? Ask the person to raise both arms and see if one arm drifts downward.
- S: Speech Difficulty. Ask the person to say a simple phrase. Is he or she hard to understand?
- T: Time to call 911. If the person shows any of these warning signs, call 911 and note the time the first symptoms appeared.
Dr. Caprio cautions that everyone responds to a stroke differently. “I want to emphasize that it may not be a full inability to speak or complete paralysis, for example. It’s any sudden loss of neurologic function.” So, even if a person's symptoms seem relatively minor, seek medical attention.
What Is the Telestroke Program?
Once you are at your local hospital, the emergency department may call leading stroke specialists at Northwestern Medicine for assistance and guidance through the telestroke program. This brings added expertise and resources to hospitals that may not have a Comprehensive Stroke Center.
The Northwestern Medicine telestroke program features a two-way video and audio system that allows a board-certified neurologist from the Comprehensive Stroke Centers at Northwestern Memorial Hospital and Northwestern Medicine Central DuPage Hospital to conduct a virtual physical examination and collaborate with the emergency medicine teams at area hospitals.
The Northwestern Medicine telestroke program is offered to several hospitals in Illinois, including Northwestern Medicine Lake Forest Hospital, Northwestern Medicine Kishwaukee Hospital and Northwestern Medicine Valley West Hospital. It is also offered to several hospitals in northwest Indiana. These hospitals can determine if specialized care is needed on a case-by-case basis.
The videoconferencing system connects the neurologist and patient through a secure internet connection. Using the camera, the neurologist can perform observational tests, such as gauging how a patient’s pupils respond to light sources and monitoring how well the patient can move and speak. Simultaneously, through the electronic medical record, the neurologist has instant access to the patient’s medical information, including vital signs, CT scans and laboratory results.
“The telestroke program brings the neurologist to wherever the patient might be,” says Dr. Caprio. “We have immediate access to be able to examine the patient with the help of emergency room staff.”
While the neurologist is asking questions and panning and zooming the camera, the patient and family can also see the physician on a portable screen. The neurologist can advise the physicians on-site if the patient has suffered the type of stroke that responds to a potentially lifesaving clot-busting drug (tissue plasminogen activator) and whether the severity of the patient’s condition warrants transfer to a Comprehensive Stroke Center. There, the patient has access to a myriad of treatment options, including a thrombectomy, a procedure for removing a thrombus (blood clot) from a blood vessel. It is one of the most effective treatments available for those having a stroke.
“Even though the doctor and patient are separated by many miles, it is very similar to being at the patient’s bedside,” says Richard A. Bernstein, MD, director of the telestroke program at Northwestern Medicine. “Capitalizing on the resources of our Comprehensive Stroke Centers, the medical team is able to coordinate the best treatment quickly and help reduce or prevent the potentially debilitating consequences of stroke.”
When Every Minute Matters
“Immediate treatment after stroke is critical to help minimize the risk of serious brain damage,” says Andrew P. Oleksyn, DO, medical director of emergency medicine at Kishwaukee Hospital. “The goal is to diagnose and treat stroke within the ‘Golden Hour,’ or the first 60 minutes following onset of symptoms, when patients have much better outcomes.”
The telestroke program helps bridge that access. “If we are able to interact and see these patients as they’re having a stroke, we can treat them in a timely manner that can dramatically improve their outcomes,” says Dr. Caprio.
However, Dr. Caprio emphasizes that it is a team approach. “Not only do we partner and collaborate with the hospital physicians and staff members but there also is a large team that comes together to deliver care,” she says. “The telestroke technology allows the team to work in coordination to identify the issue, transfer the patient to another hospital if needed and determine the next appropriate treatment.”
In addition to the telestroke program, Northwestern Medicine’s stroke program is composed of two Comprehensive Stroke Centers accredited by The Joint Commission; two Primary Stroke Centers; a multidisciplinary physician team that includes neurology, neurosurgery, radiology and critical care; and a Mobile Stroke Unit. Like the telestroke program, the Mobile Stroke Unit brings expertise to wherever patients are — but outside the hospital walls. The Mobile Stroke Unit is a specialized ambulance equipped with tools and staff members normally only found inside a hospital. This allows the team to quickly diagnose a stroke on-site, and by coordinating electronically with a Northwestern Medicine neurologist, immediately begin treatment.
In addition, the team is always on the relentless quest for better. There are new imaging technologies, which can help identify areas of the brain at risk for stroke. The team also continues to track metrics in an effort to improve quality and offer the best care.
“The important thing is that we’re reaching patients wherever they live,” says Dr. Caprio.
Because when it comes to a stroke, every minute matters.