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Dartmouth-Hitchcock unveils ‘telestroke’ program

Last modified: 10/30/2013 11:51:19 PM
Minutes matter when treating stroke victims and, all too often, patients aren’t able to see a specialist fast enough to prevent damage to their brains.

But yesterday, Dartmouth-Hitchcock Medical Center announced a new program that will use technology to treat stroke patients in New Hampshire and Vermont more quickly and closer to home.

The “telestroke” program, created in partnership with the Mayo Clinic, will make vascular neurologists – a highly trained subspecialty within stroke care – available to consult with emergency room doctors around the clock via remote “telehealth” technology. Specialists at Dartmouth-Hitchcock or Mayo would use videoconferencing devices to talk with ER doctors elsewhere, examine patients, interpret brain images and confirm diagnosis with the physicians on-site.

Catholic Medical Center in Manchester is the first hospital to join the initiative, though program leaders expect to bring more health care providers on board soon, said Sarah Pletcher, medical director for Dartmouth-Hitchcock’s Center for Telehealth.

The program is aimed at addressing a significant challenge facing rural regions, where there are too few stroke specialists to meet the need, Pletcher said. It also helps achieve health reform goals of cutting costs, expanding access and improving care while treating patients closer to home.

“I think it really bridges the health care reform gap nicely and it is both a contract opportunity for (Dartmouth-Hitchcock and Mayo) as well as an ability to retain care at the local hospital level,” Pletcher said.

Stroke is a leading cause of death in the United States, according to the Centers for Disease Control and Prevention. More than 800,000 people die in the U.S. each year from cardiovascular disease and strokes. Sometimes called a brain attack, strokes occur when a clot blocks the blood supply to the brain or when a blood vessel in the brain bursts, often resulting in death, paralysis and speech difficulties.

Dartmouth-Hitchcock treats hundreds of stroke patients every year, Pletcher said.

Time is essential when diagnosing and treating stroke patients, when the window for lifesaving interventions is only a few hours, said Keith McAvoy, medical director of Catholic Medical Center’s stroke program, which treated 128 patients last year. The Manchester hospital signed onto the telestroke program because it will improve access to specialists that CMC does not have on staff, McAvoy said.

“With the telemedicine concept and setup, you can roll a monitor into a patient’s room, turn it on and you have immediate access to a vascular neurologist,” McAvoy said.

The hospital already consults with Dartmouth-Hitchcock over the telephone before giving patients clot-busting drugs, McAvoy said. But the remote consults are awkward and limiting, as the specialist can’t actually see the patient.

Consequently, patients have to be flown to Dartmouth-Hitchcock for monitoring even after a specialist approves them for medication. The new telestroke program makes those trips unnecessary because the specialist can do a more thorough examination remotely, allowing patients to stay in Manchester for treatment.

“In an ideal world, it’s a balanced return on investment for all the hospitals involved, as well as being best for the patient and saving costs,” Pletcher said.

Fewer than 1 percent of patients in this region who might benefit from clot-busting drugs actually receive them, Pletcher said, largely because they missed the narrow window of time in which they could have taken the medicine, or walked into a hospital without a staff person sufficiently trained to help them.

The benefits to stroke patients from having immediate, albeit remote, access to specialists is one reason why Dartmouth-Hitchcock has focused telehealth services on stroke care. It is a disease in which many deaths and disabilities can be prevented by fast access to specialists, and the technology is suited to the types of consultations done with stroke patients, Pletcher said.


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