TeleSpecialists in Action with HCA: When Minutes Mean Everything

Recently we received feedback on a specific case of excellent stroke teamwork with a partner hospital of ours, Portsmouth Regional Hospital (an HCA facility) in New Hampshire. This case is a perfect example of why TeleStroke is such an important part of telemedicine and how the extensive stroke protocols that we put into place with our hospital partners are vital to premium patient care.

Blurred emergency in hospital

A man in his early 50s arrived at Portsmouth Regional Hospital from Dover Fire with stroke symptoms. The EMS team called in a Stroke Alert en route to Portsmouth Regional Hospital, which enabled the facility to have their stroke team (including the TeleSpecialist neurologist) waiting for the patient’s arrival in the Emergency Department (ED), allowing for expedited care of this patient.

The patient was diagnosed with stroke and given Alteplase (tPA) just 27 minutes after his arrival to the ED and was diagnosed with a Large Vessel Occlusion (LVO). At 56 minutes after arrival to the ED, the patient was transferred emergently to Interventional Radiology for the removal of a clot at the proximal M2 level. By the time the patient left to go up to the Intensive Care Unit (ICU), he was laughing and remained asymptomatic!

Kudos to Dover Fire and the entire team and to Portsmouth Regional Hospital: the ED physician, the ED nurses, the ED Unit Coordinator, CT and X-Ray Techs, plus the IR physicians and team. The Stroke Protocol was enacted with the TeleSpecialist neurologist and the team worked quickly and efficiently to ensure a high quality of life post-stroke for this patient.

TeleSpecialists treat every hospital that we work with as a partnership; our doctors are not just faces that beam in and beam out of the carts. They are credentialed in your hospitals and freestanding EDs. Our doctors write orders directly into your EMR to leave little to no room for error.

For more information on how TeleSpecialists can work with your facility, sign up for a demo at tele-specialists.com.

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The DAWN Trial and how it could affect stroke care at your facility.

NIHSS 3

The Background:

The DAWN (DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo), was created to measure the effects of stroke treatment in the timeframe outside the AHA and ESO guidelines of 6 hours. Funded by Stryker Neurovascular, Dr. Nogueira and Tudor Jovin, MD were named Coprincipal Investigators and led the DAWN Trial.

A 2016 analysis suggested that the benefit of thrombectomy rapidly decays over time and may no longer exist beyond 7.3 hours from stroke onset (or TLSW). (Saver et al, JAMA. 2016). The results of the DAWN are particularly beneficial for patients with wake-up strokes, strokes with an unclear onset time or witnessed late presenting strokes, which represent a large portion (around 40%) of LVO (Large Vessel Occlusion) Stroke, which previously had no proven treatment options.

The Study:

A total of 206 patients were enrolled in the study and randomly assigned a group based on factors such as site of the stroke occlusion and the time-from-last-seen-well; 107 in the thrombectomy group and 99 to the control group. Patients were randomly assigned to thrombectomy (using the Trevo device) plus standard medical care (the thrombectomy group) or to standard medical care alone (the control group). The median time of patients having received treatment in the DAWN trials was 12.2 hours and 13.2 for the control group. Patients were then followed for 90 days for results.

The Conclusion:

The study concluded that across all factors, treating stroke with endovascular thrombectomy in DAWN-eligible patients from 6 to 24 hours of symptom onset showed considerable improvement in functional independence and wellness at 90 days, versus standard care alone. Stroke can be tricky to identify but thanks to the DAWN trials, we now know that there is a larger window to treating stroke than once thought.

Tudor Jovin, MD, University of Pittsburgh School of Medicine, Pennsylvania, the study’s lead investigator, summarized: “These results greatly expand the population of patients who can benefit from mechanical thrombectomy for stroke, to significantly reduce functional impairment in the mostly severely affected patients,” he added. “Time is still obviously very important and the earlier the treatment is given the better the results, but we have shown in this trial that it shouldn’t be the only factor that determines whether we consider endovascular therapy.”

How will this impact facilities that have the capability to treat stroke patients? Patients that typically would have fallen outside of the treatment window now may benefit from thrombectomy and standard care. Any medical facility that could receive a stroke patient should review protocols to transfer patients to an EVT (Endovascular Treatment) facility as more patients can benefit from EVT. While this is certainly a pathway to a wider treatment window, “time is brain” still applies and each acute stroke case should still be treated as quickly as possible.

With the opening of this window of EVT treatment, more neurologists may be needed to assess and treat the influx of patients that now qualify in the 6-24 hour timeframe, instead of sending them straight to standard care. TeleSpecialists can implement a turnkey TeleStroke program, proving Board-certified neurologists via cart (licensed in your state and credentialed in your facility), fill any gaps in neurologist scheduling, assist your facility in stroke certification, and lower transfers of stroke patients to other facilities.

For more information on how TeleSpecialists can assist in building your TeleStroke program, contact us.

Five Important Benefits of Telemedicine

Technology is bringing patients and doctors closer than ever before as telemedicine becomes an important part of the healthcare industry. Whether its across town or across the country, patients have more freedom to choose their doctors and specialists and find the help they need when they need it. TeleSpecialists is part of this growth, specializing in building a clinical infrastructure for hospitals and clinics anywhere. Here are just a few of the benefits you’ll discover when working with telemedicine.

  • No transportation time or costs

Gas money isn’t cheap these days and neither is public transit or parking. With telemedicine, you don’t have to worry about getting stuck in a traffic jam and missing your appointment or having to travel twenty miles away in another to see a specialist.

  • Convenience for the patient

Not only does the patient not need to travel, they won’t have to take use any of their precious time off to see a doctor. Talking to a doctor through a mobile device can bring the doctor’s office to them; all they need is a break at work and a private space. There’s also less time spent in a waiting room. Telespecialists makes it easy for patients to register and log in with their medical history.

  • On-demand options

With more physicians offering telemedicine options, patients or their families can use video, voice, or even chat to discuss their medical problems. Some issues will require more hands-on care, but doctors and specialists can still help solve a myriad of problems.

  • Easy access to specialists

Need help from a specific doctor for a specific problem? With telemedicine, you can be in contact with a specialist in no time no matter where you live. After all, patients want the best care possible, not the closest. Telemedicine also makes it easy to email X-rays and MRI scans directly to the doctor without having to wait.

  • Cost-efficiency

An ever-increasing number of doctors offering telemedicine options charge less than a regular visit because of the ease of use. Not only is this a great option for doctors who want to help more people, it’s great for patients who live far away from medical care.

If you’re a physician or administrator looking for a telemedicine solution for your office or facility, look no further than the comprehensive systems of TeleSpecialists. We engineer a solution specific to every client to meet their needs – contact us today for a webinar presentation of our services.

Welcome to the TeleSpecialists Blog

Tele-Specialist Health Care
In the next decade, the Association of American Medical Colleges Center for Workforce Studies estimates there will be a shortage of over 46,000 medical specialists across the country, not to mention those living in rural areas who already don’t receive the specialized care they need. At TeleSpecialists, ensuring anyone anywhere has access to reliable and informative healthcare is our main goal. We want to solve future medical concerns through a four-step process:

Improved Access

Our Telemedicine technology reduces wait times at the busiest hospitals and clinics as well as opens treatment plans for those living in rural areas. Our services are also available 24/7 to assist neurologists, psychiatrists, and other specialized doctors when they can’t attend to patients themselves.

Cost-Efficiency

Our Telemedicine programs are designed to reduce the cost of care by reducing travel times, shortening the patient’s time in the hospital, and more. The flexibility of our systems allows hospitals, clinics, and practices to expand the types of care offered to their communities, allowing for more business and practice opportunities.

Improved Quality

Working with telemedicine specialists has been repeatedly shown in studies to be just as effective as working with a doctor in person. This means great opportunities to improve the quality of care in facilities that have limited access to specialists.

Patient Satisfaction

Nothing makes us happier than to see a happy and healthy patient. Our telemedicine services greatly reduce the unease and stress burden on the patient by reducing wait times to see specialists and improving access to advanced care.
Discover what TeleSpecialists can do for your healthcare facility and your patients. Contact us for a free demo and improve the quality of care you give today.

What Texas’ landmark telemedicine legislation means for the industry and the nation

Texas became the last state in the country to abolish a requirement that the relationship between patient and physician must be started with an in-person visit prior to the use of telemedicine. Governor Greg Abbott signed the landmark legislation on May 27, 2017, paving the way for patients to gain access to the services that telemedicine can offer them.

Texas Demonstrates a Great Need for Telemedicine

Texas seems like an unlikely state to be the last one to sign such a bill. As a state that sprawls over 268,000 square miles, and whose population is dispersed widely, Texas has a great deal of rural poverty with few healthcare services available. In fact, the state ranks 46th when it comes to the number of primary care doctors per capita. There are also 35 counties scattered throughout the state that don’t have a family physician to serve the population, making Texas the ideal market for telemedicine expansion.

Barriers to the Expansion of Telemedicine                                           

Even though telemedicine had already been practiced for several years prior, the Texas Medical Board began restricting its use in 2010. The board cited a prescribing rule, which mandated that physicians must establish a relationship with patients via an in-person visit prior to utilizing telemedicine’s services. Court cases ensued, with litigation dragging on for years.

Governor Abbott’s Action Ends Telemedicine Issue

With Governor Abbott’s signature on Senate Bill 1107 and House Bill 2697, the people of Texas can now access the convenience and expertise of board-certified physicians without unnecessary red tape. This welcome decision brings access to much-needed healthcare to citizens across the state.