When it comes to stroke, there is a critical three-hour window. From the onset of symptoms, the stroke patient has only three hours to receive the clot-busting drug tissue plasminogen activator (tPA), which offers a greater than 30 percent chance of improvement for acute stroke patients.
In August of 2005, a telestroke project was initiated to further support the treatment of acute stroke and to eliminate the geographic barrier between rural patients and stroke specialists. The Southwestern Ontario (SWO) Stroke Strategy, the Ontario Telemedicine Network (OTN), London Health Sciences Centre (LHSC) and Chatham Kent Health Alliance (CKHA) partnered for the telestroke project, which is funded by the Government of Ontario.
BRAINSAVE (Bringing Regional Assessment in Stroke and Virtual Education) aims to build regional capacity for the assessment and treatment of acute stroke patients using videoconferencing and teleradiology. Within Southwestern Ontario, the telestroke project has a three-fold purpose. The first is to build capacity through mentorship of regional teams in the administration of acute stroke treatments. The second is to improve access to tertiary expertise at London Health Sciences Centre for complex patients. Finally, telestroke supports decision-making regarding the transfer of patients from across the region, to London, for tertiary care.
An ideal environment
An aging and largely rural population coupled with a vast geography — 28,800 km — characterizes the SWO region where severe winter weather results in regular road closures. There is a critical shortage of physicians and other healthcare professionals. These traits mean that the administration of tPA can be difficult to accomplish within the requisite three-hour window.
OTN provides a secure, IP-based videoconferencing network with access to more than 700 videoconferencing endpoints province-wide and serves more than 300 healthcare sites and academic institutions across the province of Ontario. The network allows patients in the province's rural communities to meet with specialists, regardless of physical location.
Regional assessment in stroke
The CKHA-LHSC telestroke project went live weekdays between 9 a.m. and 5 p.m. for patient care on Aug. 20, 2005.
BRAINSAVE operates over a secure network connection with a PolyCom (Pleasanton, Calif.) iDOC (mobile videoconferencing terminal) in the emergency department of CKHA and a PolyCom VSX3000 (desktop videoconferencing unit) in the emergency department of LHSC. CT images are transferred between CKHA and LHSC using a direct image push from the CKHA CT scanner to the LHSC PACS (GE Healthcare, Chalfont St. Giles, U.K.).
Teams of physicians collaborate at both sites to provide urgent stroke care. BRAINSAVE allows London neurologists to help assess stroke patients in the Chatham emergency department in real time, providing mentorship and support to the Chatham physicians. It is vital that in addition to seeing the CT scan taken in Chatham, the London stroke specialist sees and interacts with the patient for visual cues during a battery of tests. The technology allows the patients and the patients' families to be involved in all aspects of the care process.
BRAINSAVE will expand coverage to 24/7 in 2007 with London physicians providing after-hours telestroke support from their homes. Laptops outfitted with Polycom Via Videos were deployed to the physicians to facilitate this support.
BRAINSAVE differs from other acute telestroke models of care as it is premised on a mentorship model, thus building community capacity to treat acute stroke as well as supporting knowledge transfer via online learning modules. BRAINSAVE also ensures patient and family member involvement in the care process.
By building regional capacity, the partners are addressing human resource shortages and supporting physician recruitment in the region. Rural physicians are attracted to Southwestern Ontario's telehealth capabilities with the knowledge that hospitals are connected. This relieves feelings of professional isolation, enables timely consultations with colleagues in larger centers and allows personal contact with patients transferred to other hospitals for care.
The next level
Early results show BRAINSAVE to be a successful model for building regional capacity for acute stroke treatment. Patient transport is being avoided, healthcare providers have expressed satisfaction with the opportunity to access real-time patient care mentorship, and patients and families are pleased with the hospital-to-hospital collaboration.
Jennifer Mills Beaton is project leader of the Southwestern Ontario Telestroke Program.