Teleneurology Impacting Rural Areas


Baptist Memorial Healthcare System expanding its neurology reach

Every 40 seconds, someone in the United States suffers a stroke, which is one of the leading causes of death. Having access to an experienced neurologist can make a difference in the outcome but while the demand for neurologists is high, unfortunately the supply is short. This fact is further compounded for many who live in rural areas, which makes access to a neurologist even more limited. Fortunately, technology has made neurology more accessible in West Tennessee.

Through the use of teleneurology, expert care can be quickly available to even the most remote locations, an important consideration since every second counts in treating stroke and other neurological emergencies. The American Academy of Neurology views teleneurology as an effective tool for rapid evaluation of patients in remote locations.

Patients in rural West Tennessee are reaping the benefits of this technology. Baptist Memorial Healthcare began using a telemedicine platform for stroke and acute neurology in 2012. In 2015, the system switched to the Patronus Neurology platform to provide the teleneurology consults. The clinical program is now in place at ten hospitals across the system, including Tipton County and most recently, Union City. Plans are to expand the program to all facilities system wide by 2019. Baptist Memorial Hospital - Huntingdon is projected to come online sometime next year. Options for telemedicine in the outpatient neurology setting are being explored as well.

Kimberly Hallum Stewart

"Recruitment of specialists, especially in neurology and neurosurgery, is often very difficult for our small to mid-size facilities and communities. The neurologists we have on staff have their hands full with covering their clinic and in-house responsibilities. Having them try to cover outlying facilities would be difficult," said Kimberly Hallum Stewart, system administrator of neurosciences for Baptist Memorial Healthcare Corporation in Memphis. "Telemedicine brings those specialists to those areas. The company we work with, Patronus Neurology, are trained vascular neurologists with specific stroke training that only do telemedicine. They assign a team of physicians who work only with our system and provide an on-call physician as well as a back-up, so if we have multiple patients over multiple facilities we are covered."

The lead time to start a telestroke program is about three to four months. The technical platform must be in place, which consists of the cart and software system that will be used. Clinicians have to be educated on the process for using the cart and activating a request for a consult. The EMR systems used by Baptist facilities and that used by Patronus all interface so that orders and reports can be transmitted electronically. Patronus physicians are introduced to the staff and physicians as well as credentialed at the facility. Staff also receive additional training on how to identify and care for a stroke patient as well as administer Activase (tPA).

Overall, it is a pretty easy process," said Stewart. "In a rural hospital, the age of the infrastructure can impact the time it takes to get things up and going. We have to make sure the wireless capability of the facility can handle the system. We do a ton of testing before it is up and running and take the cart everywhere it could possibly have to go to make sure there are no kinks. But just like with cell phones and computers, there can always be a glitch, but our physicians can always do the consult by phone if necessary."

Baptist Memorial Hospital - Union City was an ideal facility for this type of program says Stewart. "They have emergency department physicians and hospitalists that are on the ground to care for the patient during and after the telestroke consult," she said. "The program is ideal for any adult patient that is undergoing an issue that the healthcare provider, whether in the field or ER, feels needs a neurology consult."

A typical consult starts with a patient presenting to the ED or on an inpatient unit with a stroke or stroke-like symptoms (or any other emergent neurological event). They are quickly examined and in the case of a code stroke, the patient is immediately taken to CT. While the patient is in CT, the clinician enters an order in the EMR for a teleneurology consult that goes directly to Patronus. The Patronus neurologist connects to the hospital via a telemedicine cart and is able to see the patient, family, nurses as well as physician and communicate directly with them.

"The neurologist controls the camera on the cart which can pan left, right, up and down to examine the patient and has an amazing picture quality," said Stewart. "It also has 30x zoom lens, so they can look at the patient's pupil. The nurse is always in the room with the patient.

The neurologist discusses the options with the family and determines the next steps to be taken, be that to start tPA, admit to the hospital or transfer to another facility that provides a higher level of care. All of this typically happens in less than 60 minutes. After the patient leaves the inpatient setting, the appropriate referrals and appointments are made for follow-up care whether that be with a specialist in Memphis or by a local physician.

Stewart says the system has been well received by both staff and patients. "When the cart rolls in, patients interact with the physician just as they would if they were in the same room," she said. "The ER staff and physicians love it. The ability to have the Patronus physician be a part of the medical team and work with the patient and family is invaluable. They follow the patient in real time with real data from start to finish. If the patient is transferred, they make sure the admitting physician has all the information from the consult prior to the patient's arrival in Memphis."

Across the Baptist system in 2017, over 2100 patients with neurological emergencies were treated and cared for via telemedicine. "Union City has a busy emergency department, so we expect the volume at the facility to grow each month," said Stewart. "Based on what we see in other facilities their size, we expect there to be 10-15 consults a month."


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