East Georgia Regional Medical Center deployed its new tele-stroke and tele-neurology carts and their 24-hour, seven-day connection to neurologists specializing in stroke treatment for the first time last week.
Wednesday morning, the system was used in the treatment of a patient experiencing a stroke. The carts include a high-resolution digital, live-action camera capable of reading 11-point type, roughly the size of this newspaper text in the print version, from 15 feet away.
More to the point, the neurologist who appears on the screen can look closely at a patient’s eyes and check the reactivity of the pupils. The cart also carries a microphone-backed stethoscope, which a nurse at bedside positions on the patient for the neurologist to listen remotely to heartbeat and blood flows.
“A stroke is, to me, a stroke, no matter where you’re located, and that patient requires immediate, urgent evaluation for stroke treatment, and that’s why even if the patient is 2,000 miles away, to me I feel like I’m in the same room,” said Dr. Vikas Pandey, a neurologist based in Dallas, Texas.
Board-certified both in neurology and specifically in vascular neurology for treatment of strokes, Pandey is one of the three neurologists on-call at East Georgia Regional Medical Center through a contract with the multispecialty telemedicine group Access Physicians.
The group is also headquartered in Dallas, but the other two neurologists it has assigned to answer calls from EGRMC are Dr. Alex Shikhman, based in Miami, Florida, and Dr. Matthew Dillon, in the Detroit, Michigan area.
When a call comes in from the Statesboro hospital, one of the three doctors is promised to be on screen to see a patient here within 15 minutes. But Pandey and EGRMC’s Chest Pain and Stroke Program Coordinator Bryan Realiza both indicated that it will happen faster, usually within 10 minutes.
Time of the essence
When a stroke is suspected, the neurologist will be evaluating whether the patient should receive Alteplase, a drug that can be very effective in treating ischemic strokes if administered in time.
“There is a time limit with that medication, so that’s really the key, I think, as to the growth of tele-neurology and tele-stroke,” Pandey said. “If you have an in-person doctor trying to take care of a patient and trying to decide if they were eligible to receive the medication, they’d either be on a phone call with an E.R. doc and trying to guess, or they would have to drive in and do an in-person exam. Both of those are not optimal.”
For Alteplase to work, it must be given within four and a half hours of the onset of symptoms, the hospital stated in a news release. Interviewed Wednesday, when he also got Pandey on the phone, Realiza noted that the American Stroke Association recommends administering the medication within 60 minutes of a patient’s arrival.
“With tele-stroke we’re able to get on screen within 10 minutes and evaluate the patient right away, see the exam for ourselves and make an educated and informed decision and counsel the patient on risks, benefits, review all the contraindications to the medication, and then really convey a clearer picture in terms of stroke treatment,” Pandey said.
Realiza differentiated between the tele-stroke program, which will be available 24 hours a day, seven days a week for patients who present with stroke symptoms, and the tele-neurology program.
Tele-neurology is also available at EGRMC from the Access Physicians neurologists, using the same two carts and connections. But tele-neurology, as distinguished from stroke diagnosis and treatment, will be limited to 8 a.m.-5 p.m., also seven days a week.
Examples of patients who might use that less-urgent service include those experiencing migraines or vision problems that may have neurologic causes, Realiza said.
Two Statesboro-based neurologists, Dr. Kashyap Patel and Dr. Michael Taormina, are affiliated with East Georgia Regional Medical Center, and hospital officials emphasized that the tele-stroke and tele-neurology program will not replace them.
“They both own their own practices here in town, and we love them,” Realiza said. “However, they still have to run their practice, so if a patient comes in and it’s an emergency, they’re forced to break away from patients at their office as they respond to emergencies here, which isn’t the ideal situation.”
“The tele-neurology just makes it immediate,” Dr. Alan Scott, EGRMC’s chief of staff and medical director of its emergency department, said a few minutes later. “You have a doctor there 24-seven, and it’s hard to keep a doctor from their office here in the hospital. So we support our local physicians very much, but it just gives us an added resource for when you need that neurology person immediately.”
Seeks to be Stroke Center
Realiza is not a doctor but holds master’s degrees in both business administration and healthcare administration. He previously worked in the hospital as a cardiac ultrasound technician but became its full-time chest pain and stroke coordinator in November 2018.
He helped guide EGRMC’s successful effort to become an Accredited Chest Pain Center. The American College of Cardiology awarded that status last August.
Now the hospital is working toward Primary Stroke Center certification from the Joint Commission.
Realiza is also starting a stroke support group. Just one family caregiver of a stroke patient attended the first announced meeting last Tuesday evening. Realiza hopes for more patients and caregivers at the next session, slated for 5:30-6:30 p.m. March 17. The group will meet on the third Tuesday of alternating months in the hospital’s education room, near the cafeteria.
Stroke a leading killer
He advises calling 911 immediately if you see or experience one or more signs of a stroke: sudden numbness or weakness of the face, arm or leg, especially on one side of the body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness or loss of balance; or sudden severe headache with no known cause.
Stroke is the fifth leading cause of death in the United States, accounting for about one in 20 deaths, according to the Centers for Disease Control and Prevention.
With 43.5 stroke deaths per 100,000 people as of 2017, Georgia has the eighth highest stroke death rate among the 50 states, according to the National Center for Health Statistics. In 2017, the nationwide average was 37.6 deaths from stroke per 100,000 people The Southeast as a region has the highest rates of stroke mortality, as shown on the CDC website at www.cdc.gov; search “stroke maps.”