For the past few years, teleneurology programs have been echoing the "time equals brain" mantra in explaining why they're needed to help treat victims of ischemic stroke. Now they have the numbers to back that up.
A team of researchers from UCLA has completed a major study on the use of tissue plasminogen activator, or tPA, on stroke victims within 4.5 hours after the stroke occurs. That study of more than 50,000 stroke patients, reported in the June 19 issue of JAMA, The Journal of the American Medical Association, confirms that the sooner tPA is administered, the better chance of recovery.
"We know from brain-imaging studies that in humans, the volume of irreversibly injured tissue in the brain from an ischemic stroke expands rapidly over time, consuming 2 million additional neurons every minute until blood flow to the brain is restored," said Jeffrey Saver, a professor of neurology and director of the UCLA Stroke Center, in an interview with ScienceDaily. According to Saver, the study found that every 15 minutes saved in administering tPA led to a 3 percent better chance of going home, a 4 percent better chance of walking at the time of discharge, a 4 percent less likelihood of hemorrhaging in the brain, and a 4 percent reduction in mortality rates.
Those improved odds are just what the doctor ordered for companies like AcuteCare Telemedicine, an Atlanta-based company that's billed as the largest practice-based provider of teleneurology and other telemedicine services in the Southeast. Licensed in eight states and currently practicing in Georgia, Alabama, Tennessee and Florida, ACT is making an aggressive push to help smaller hospitals and networks that don't have immediate access to neurologists.
"We're available for any emergency neurology consultations," said Keith Sanders, ACT chief operations officer. "We really feel that we can help hospitals of all sizes – hospitals with no coverage, or some coverage, or that can provide everything except the neurologist."
While the UCLA study helps pin down the importance of delivering tPA in a timely manner, Sanders pointed out that the American Heart Association recently revised its guidelines on stroke care to include telemedicine. Once questioned for their effectiveness and safety, telestroke services are now slowly gaining favor within the healthcare hierarchy.
"We're making progress," Sanders said. "ER doctors now want the neurologists to be a part of the decision-making process."
One of the more popular methods of providing telestroke services is through the "hub and spokes" method, where one large hospital at the center of a large area establishes a stroke center and provides services to outlying hospitals and clinics. One such setup was launched in May with the Southeast Alabama Medical Center's Stroke Care Network, established in Dothan, Ala., in collaboration with ACT, the Southeastern Alabama Medical Center Foundation and the Alabama Partnership for Telehealth. The network provides stroke services for a 240-square-mile swath that includes southeast Alabama, southwest Georgia and the Florida Panhandle.
"We assessed our communities to identify where we could devote resources. We found an increase in mortality and morbidity due to stroke," said Cecelia Land, SAMC's division director for rehabilitation services, in a case study prepared by ACT. "We recognized an immediate need to establish a stroke care network, providing patients with access to 24x7 teleneurology."
In creating the network, SAMC secured funding from its foundation to purchase the necessary infrastructure and telemedicine equipment from ACT, and now contracts with ACT to provider round-the-clock teleneurology services. SAMC officials hope to add more "spokes" to the network, in the form of hospitals and clinics, and also want to use the network to educate communities on the importance of wellness and identifying precursors to a stroke.
Sanders hopes to extend ACT's telemedicine platform to other specialties, such as telepsychology, and he expects more hospitals and health networks will buy into the system as executives see the benefits of sharing specialist services without having to house them on-site.