November 14, 2008

Program connects rural hospital with VMC stroke experts

Featured Image

Adrian Jarquin-Valdivia, M.D., at left, demonstrates the TeleStroke program to fellow physicians. He talks on a cell phone to staff at Hardin Medical Center while a patient's video image and medical information are
displayed on the screen. (photo by Anne Rayner)

Program connects rural hospital with VMC stroke experts

After a stroke, patients have only three hours to receive the best treatment, and a new program at Vanderbilt Medical Center is trying to make the most of that small window of time.

The TeleStroke Program, which launched Nov. 1, electronically connects VMC stroke neurologists with staff at Hardin Medical Center in Savannah, Tenn., to provide faster diagnosis and initiation of treatment.

“As time goes by, the risks go up and benefits go down, so the sooner the better. As we say, 'Time is brain,'” said Adrian Jarquin-Valdivia, M.D., assistant professor of Neurology.

The Vanderbilt Stroke Center, which oversees the program, is directed by Howard Kirshner, M.D., professor and vice chair of Neurology.

“We are hopeful that this will be the first step in creating a network of rural hospitals which can connect with Vanderbilt to provide state-of-the-art stroke treatment to many more of the residents of Middle Tennessee than has been possible before,” Kirshner said.

The ultimate goal is to diagnose the patient within the three-hour window so that tissue plasminogen activator (tPA), a clot-busting drug, can be administered.

“As a major medical center, we are often referred stroke patients who are initially taken to smaller facilities, and by the time we get patients, we are often past the window to use tPA,” said Jackie Moreland, R.N., M.S., stroke coordinator.

When physicians are on TeleStroke call, they will carry a laptop with built-in camera. Hardin Medical Center is equipped with a mobile cart containing a laptop and more sophisticated camera. The staff communicates verbally via cell phone and visually via the cameras.

The software program, developed by REACH, displays patient vital signs, lab results and CT scans on the laptop screen. There is a countdown clock for tPA administration and a large camera feed with controls underneath.

With a click of the mouse, the physician can pan around the room or zoom in for a better look.

Medical staff at Hardin has been trained to assist VMC physicians with the physical examination using the National Institutes of Health Stroke Scale. Based on those results, the physician decides whether to administer tPA. They click a button and orders are formulated based on the patient's weight. They can then add follow-up instructions or request for transfer.

Kirshner and Jarquin-Valdivia both feel that an electronic diagnosis is comparable to a face-to-face consult.

“It is a beautiful application of telemedicine,” Jarquin-Valdivia said. “The beauty is that more acute stroke patients have access to stroke neurologists, which increases the probability of receiving the FDA-recommended therapy. It is also a way to establish stronger clinical relationships with other hospitals not just for stroke care, but for collaborations in other areas of patient care and research. The ultimate beneficiaries are the patients,” Jarquin-Valdivia said.

The yearlong pilot program is funded by a $60,000 grant from Delta States Stroke Consortium. VMC was chosen to be the first hub because of its ongoing interest in telemedicine, its status as a major medical program and its central location.

“If all goes well, the goal is in one year for the Delta States Stroke Consortium to fund similar programs in east and west Tennessee, so there will be three hubs with many prospective spokes,” Moreland said.

In addition to Kirshner and Jarquin-Valdivia, Anne O'Duffy, M.D., and Derek Riebau, M.D., both assistant professors of Neurology, will take TeleStroke call.

For more information about the Vanderbilt Stroke Center, visit <a href=""></a>.