Emergency-room providers could often use outside support. With TeleStroke–our audio and/or video network–specialists like our vascular neurologists can offer just that. In the study “Telestroke Value through the Eyes of Emergency Medicine Providers: A Counterfactual Analysis,” researchers measured how much of a difference this system can make.
How Department Neurologists Are Helping to Treat Strokes in ERs in 6 States . . . from Their Desks
Department Contributors: Jennifer Majersik, MD, MS; Ka-Ho Wong, BA, MBA; Piotr Tekiela, MD; Holly K. Ledyard, MD
When a possible stroke patient arrives at a local hospital, emergency-room providers will quickly try to determine if this person is experiencing a stroke—and if so, what kind of stroke, how long it has been since its onset, and what treatments the patient is eligible for. These determinations are complex and time-sensitive, and they often require specialized knowledge, like that of our stroke-specialized neurologists.
The use of TeleStroke–our audio and/or video network–has given ER providers a way to consult with our vascular neurologists despite the urgency, the current shortage of neurologists, and the large geographical distances between the University and these other hospitals.
The TeleStroke Network’s Impact
Recently, in the study “Telestroke Value through the Eyes of Emergency Medicine Providers: A Counterfactual Analysis,” researchers led by Dr. Majersik sought to measure how meaningful TeleStroke consults were to emergency providers and their patients. The results showed that TeleStroke consultations changed the diagnosis in 60% of all patients and treatment plans in 56% of non-stroke patients, meaning that our TeleStroke network is also helping patients without stroke. This is a novel finding, as most studies focus only on TeleStroke effects on stroke patients. The study also explored why emergency providers requested these consults and what specific changes they made to patients’ care.
Why Emergency Providers Use TeleStroke
The most common stroke symptoms are slurred speech; trouble walking; confusion; and loss of feeling or weakness in the face or limbs, especially if it’s all on one side of the body. However, some stroke patients—most commonly women—experience less common symptoms such as nausea and vomiting, migraine, memory problems, and loss of consciousness. These variables make accurate diagnosis a moving target for providers.
Accurate diagnosis isn’t the only reason a provider might ask for a TeleStroke consult, though. In fact, the most common reason (71% of survey responses) was that emergency providers wanted expert opinions on their patients’ tissue plasminogen activator (tPA) eligibility. This eligibility has to do with strokes being either ischemic, meaning an obstruction is blocking blood flow to the brain, or hemorrhagic, meaning a brain blood vessel has burst. If a stroke is ischemic, the first treatment to consider is intravenous tPA, a protein able to break down clots. However, there are several factors to take into account when determining if a patient is eligible for tPA, such as how long they’ve been experiencing a stroke, if they’re at risk of bleeding, or if they’re pregnant. Because of these considerations, emergency providers often seek specialized advice.
This study also revealed an important education opportunity: of the emergency providers who participated in the study, 90% did not feel confident in their ability to determine a patient’s eligibility for thrombectomy, the surgical removal of a clot, which is a particularly useful procedure if tPA treatment would increase a patient’s bleeding risk. With this information, department neurologists can focus future training on thrombectomy candidacy identification.
What Effects Did TeleStroke Consults Have?
According to the study, TeleStroke frequently affected patient care. Without these consults,
- 85% of acute ischemic stroke (AIS) patients would not have received tPA
- 50% of non-AIS patients would not have received recommendations for additional imaging
- 10% of non-AIS patients would not have received recommendations for additional labs
- 40% of non-AIS patients would not have received recommendations for medication changes
- 50% of those patients would not have been transferred
Additionally, 94% of emergency providers reported that the patients and their families were satisfied with TeleStroke, and none of the providers felt their medical knowledge was doubted because of using TeleStroke.
A Promising Network
This study brought the promising news that the University of Utah’s TeleStroke network is addressing several of the obstacles in stroke care. Not only did 93% of consults result in emergency providers being more likely to use TeleStroke again, but 86% of providers reported increased confidence in their knowledge of stroke patient management.
