Physician and patient experience: a telestroke case study

Telemedicine is a way to connect a remote doctor or physician or any kind of specialist with a patient and, in this instance, with a rural emergency room.

It usually involves videoconferencing, where a remote physician can examine the patient. The remote physician can also interact with the local physician on-site and look at the CT scans and images. It's basically a way to bring a doctor electronically to any emergency room or any patient anywhere.

I was at my home at the time, and I got the call. It's probably about 100 miles from where I was at the time. They have a little telemedicine cart in their ER and we have a Web-based system, so I was able to use my laptop computer and log on and work the camera and see Thomas.

I was able to interact with him and evaluate his disability. I found that he had right-sided weakness and couldn't speak. I looked at his CT scan and was able to consult with the emergency room physician there. Together we made the decision that he should be treated with IV t-PA. Then after that we helicoptered him to MCG [Medical College of Georgia], the tertiary care center.

I think it's a growing trend, but we have a long way to go. Recent studies showed that about 64%¹ of United States hospitals had not used t-PA in the last 2 years. So we have a long way to go, but this is 1 answer to the issue.

There are 2 reasons we don't treat enough people with t-PA. One is that patients don't get to the hospital in time. And the second reason is that they'll go to a hospital that isn't comfortable using t-PA because they don't have a stroke specialist. Telemedicine helps us with that second reason.

We've got to bring specialists to these hospitals via telemedicine or other means. And then we've got to educate the public about getting patients to the hospital even quicker.

The issue is that t-PA has to be given within 3 hours of the onset of symptoms, which doesn't allow much time. It doesn't allow us to drive to an emergency room an hour away if we're a consultant.

Less than 5% of Americans with acute ischemic stroke receive t-PA. Some physicians perceive it as being a little risky, because it can cause bleeding, and acute ischemic stroke can be difficult to diagnose.

Safety Information
All thrombolytic agents increase the risk of bleeding, including intracranial bleeding, and should be used only in appropriate patients. Not all patients with acute ischemic stroke will be eligible for Activase therapy, including patients with evidence of recent or active bleeding; recent (within 3 months) intracranial or intraspinal surgery, serious head trauma, or previous stroke; uncontrolled high blood pressure; or impaired blood clotting.

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There's not an easy measurement of acute ischemic stroke, like there's an EKG for heart attack, so it requires a lot of specialist expertise. Ideally, acute ischemic stroke should be treated by an emergency physician in consultation with a neurologist or stroke specialist. And getting those 2 people together within 3 hours and making that decision can be challenging.

Well, most of the discussion I don't remember. I couldn't speak and couldn't really understand what people were saying. My wife was the key. When she realized that I was having a stroke, she immediately dialed 911, and when the ambulance drivers got there they knew about the telemedicine in Royston, which is just a few miles from my house.

So they took me there, and they screened and diagnosed me with AIS. They reviewed my history and gave me t-PA. By the next morning, I felt like I was getting back to normal. Over time, I was able to get back to work.

Case drawn from actual patient. Individual results may vary.