Idaho Health System Saves $1.7 M in Transport Costs

Before the telestroke program began last November, patients were seen in the ED and transferred to SARMC without the benefit of early treatment.

“Treatment is time dependent, so we want to make sure that patients who are candidates for treatment get that treatment as soon as possible,” says Whitener. “That’s really what telemedicine has allowed us to do, and allowed us to extend our primary stroke center out to other hospitals.”

Whitener says it is easy for a neurologist to assess a patient from a distance and identify candidates for treatment. The neurologist uses the robotic video conferencing device for different assessments: to zoom in on the patients pupils to see dilation, to relay instructions to a patient to lift their arms or squeeze the hand of the onsite clinicians, to direct a patient to repeat sentences to check for slurred speech, and to check brain cat-scans for signs of bleeding. If a stroke has occurred, then Alteplase, a drug that is typically ordered to treat stroke, can be prescribed in the recommended one to three-hour treatment window.

Three neurologists (soon four) are a part of this program and use an encrypted laptop to perform their consults. If the patient stays at the local facility, the Saint Alphonsus physician dictates into that rural hospital system’s dictation line, which is transcribed and input into the electronic health record (EHR). But if the patient is transferred to Saint Alphonsus, the physician dictates into the Saint Alphonsus system and copies the referring site. However, communication is still a challenge.

“One limitation to telemedicine is that it is difficult for remote physicians to be the admitting physician, so they have to communicate very clearly to the physicians who are going to be admitting that patient,” says Whitener. “We just need to make sure that all information is communicated.”