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UVMC Adds TeleStroke Network

Technology linking stroke patients and the care team at the UVMC Emergency Department (ED) with a neurologist is helping to close the window of time needed to assess and begin treatment in the ED.

The Premier TeleStroke Network, now active at UVMC, is a secure two-way audio/video link that allows immediate access for the neurologist, emergency physician, patient, family and caregivers to see and talk with each other to effectively assess the medical situation and discuss critical next steps. The connection allows the off-site neurologist to check vital signs, examine CT scans, review the patient chart and visually examine the patient.

“The neurologist has access to vital information in real time. It is as if they are in the room, but physically they are not,” said Ivy Thoman, RN,MS,ACNS-BC,CEN, Clinical Nurse Specialist in the ED. Time is a major factor in the treatment of a stroke because of the potential damage an active stroke can cause in the brain, she explained, adding, “Time equals brain cells.”

The TeleStroke Network provides access to the neurologist within minutes of the patient’s arrival. “To be able to provide this service is phenomenal. It gives a group of patients access to care and a specialist very quickly,” Thoman said.

Detection of a stroke usually is made by a patient’s family or a friend. What happens in response can be key to survival and recovery.

“We ask that families call 911 and allow EMS (Emergency Medical Services squads) to transport the patient to the hospital. They can start IVs and get treatment started,” Thoman said.

EMS squad members also notify the ED of a possible stroke patient on the way.

If the ED physician evaluates the patient and confirms a probable stroke, that sets off an in-house stroke alert. The neurologist (a stroke specialist), who carries a specially outfitted laptop when on call, is contacted, and a team of caregivers – from nursing, lab, imaging, respiratory and chaplaincy to assist with family – is coordinated.

The CT scan helps responders determine what type of stroke is involved and whether a “clot busting” medicine now available is appropriate for use. The ED physician and the neurologist coordinate care as more information is obtained and the Telestroke cart with the videoconferencing equipment is brought in.

The Telestroke camera linking the patient and neurologist can be run by the physician or a nurse. Thoman said the ED nurses underwent extensive training prior to implementation and have ongoing requirements to stay current.

UVMC had around 25 stroke alerts in the first three months the network was initiated. Positive feedback has been received from families and patients, and good outcomes have been experienced, said ED Director Dee Mullen, RN,BSN,MHA.

“The Telestroke Network is a blessing for patients and the hospital,” said ED Nurse Manager Yvonne Baker, RN,BSN,MSN. “As I watch the patients and their families interact with the neurologist via the telemedicine screen, it is amazing and very comforting to them,” she added. “Telemedicine stroke technology truly can enhance the quality of life for our stroke patients.”

The FAST test for warning signs of stroke:

• Face: Ask the person to smile. Does one side of the face droop?
• Arms: Ask the person to raise both arms. Does one arm drift downward?
• Speech: Ask the person to repeat a simple sentence. Does the speech sound slurred or strange?
• Time: If you observe any of these signs (independently or together), call 911 immediately.

(Source: National Stroke Association)

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*The current wait time is an estimated wait time before a person sees a physician and is not a guarantee. It is based on patient activity (how many patients are being treated and the severity of their injuries) within the last hour, and it is subject to change at any moment. If you are experiencing an emergency, call 911.