Wednesday, June 08, 2011
PHOENIX — A donation from a generous Mayo Clinic benefactor is contributing to enhanced evaluation and treatment of patients exhibiting symptoms of stroke — especially patients in rural settings where there may be limited access to stroke neurologists.
The benefactor, Mr. Wesley Remington, St. Joseph, Mo., is a strong advocate for innovative technology that can bring the stroke specialist to the "bedside," at least virtually.
Mayo Clinic in Arizona initiated the planning of its stroke telemedicine program in 2005, when statistics revealed that 40 percent of residents in Arizona did not live in an area where they were availed of stroke expertise.
Use of a stroke robot allows the patient in the rural setting to be "seen" by the specialist — in real time. The Mayo stroke neurologist, whose face appears on the screen of the robot, consults with emergency room physicians at the rural sites and evaluates the patient via Internet-based telemedicine, often called "telestroke."
Patients showing signs of stroke can be examined by the neurologist via computer, smart phone technology, portable tablets or laptops. In addition to assessment of the patient, the neurologist can view scans of the patient's brain to detect possible damage from a hemorrhage or blocked artery.
A major benefit of the collaboration between the primary stroke center at Mayo Clinic Hospital, Phoenix, and the remote site is that patients with stroke symptoms who meet the criteria can often be administered clot-busting medications within the narrow window of time necessary to minimize permanent injury to the brain. Since network inception, Mayo Clinic Telestroke has boosted, by an impressive ten-fold, opportunities for patients located in rural areas to receive clot-busting drugs.
Mr. Remington has appreciation for the promise of telestroke, both in his home state of Missouri — and in Arizona. He became familiar with Mayo's program after having a stroke himself and learning about Mayo's telestroke program. His goal is to bring such a program to his hometown of St. Joseph.
Mayo Clinic was the first medical center in Arizona to do pioneering clinical research to study telemedicine as a means of serving patients with stroke in non-urban settings, and today serves as the "hub" in a network of 10 "spoke" centers, all but one in Arizona.
Bart Demaerschalk, M.D., Professor of Neurology, and medical director of Mayo Clinic Telestroke, is the principal investigator of a major study funded by the Arizona Department of Health Services that examined the efficacy, safety, and quality of telemedicine for stroke patients in rural communities. The study, Stroke Telemedicine for Arizona Rural Residents (STARR), looked at the time-sensitive administration of the clot-busting drug, tissue plasminogen actitivator (TPA). Preliminary results of the trial, according to the researchers, are significant in confirming telemedicine as an effective tool to bring timely treatment to patients, with fewer complications and good long-term outcomes.
"We have learned that the telestroke modality is efficacious, safe and cost-effective," says Dr. Demaerschalk. "Collaboration between stroke neurologists and physicians at the remote sites has resulted in 96 percent accuracy in diagnosing stroke."
To date, more than 500 emergency consultations for stroke between Mayo stroke neurologists and physicians at the spoke centers have taken place. Such comprehensive evaluation techniques, leading to appropriate treatment for stroke, have resulted in significant cost reductions in terms of ground and air ambulance transfer of the patient to another medical center.
By July 1, 2011, the Mayo Telestroke program is expected to advance beyond the boundaries of Arizona to Missouri — to the benefactor's hometown, St. Joseph, where Heartland Regional Medical Center will collaborate with Mayo Clinic via a regional telestroke network. Neurologists from both Mayo Clinic in Arizona and the 351-bed hospital at Heartland Regional will consult, peer-to-peer, on treatment options for stroke patients.
"Excellent, capable neurologists at Heartland Regional Medical Center can ring the telestroke hotline and be instantly connected with Mayo Clinic's stroke experts," explains Dr. Demaerschalk. Mayo's Telestroke program boasts a one-minute median response time. "Urgent and immediate virtual care can be provided to patients, all because of the Remington family generosity."
Mr. and Mrs. Remington, whose names are synonymous with philanthropy, are familiar citizens in St. Joseph and beyond because of their generous support of education, art, nature, science, and health care. Their gift to Mayo in turn supports more than the telestroke program in St. Joseph — the dollars also go back to Arizona, in part to help support telestroke programs at La Paz Regional Hospital in Parker, Ariz. The hospital, whose website boasts, "Smaller Size, Big Results," takes pride in its advances in technology — including its telemedicine collaboration with Mayo Clinic.
In the 28 months since the program began, La Paz has already recorded 33 consults on strokes. La Paz Hospital joined the telestroke network with Mayo in January 2009, funded by the Arizona Department of Health Services and the STARR study. The Remington family gift will now help sustain the program in this community.
According to Vickie Clark, CEO at La Paz, "We know first-hand that 'time is brain' and being a part of this program offers our remote county a life-saving connection to Mayo's neurologists and technology. We are very grateful to the Remingtons."
Mayo's stroke telemedicine outreach, once reserved for smaller, rural communities, has now evolved and expanded to serve an urban medical center of significant size — Arizona's only public hospital, Maricopa Integrated Health System (MIHS), where 20,000 inpatient admissions and 300,000 outpatient visits annually are recorded. Now MIHS has expanded its service to patients who arrive at the emergency room experiencing symptoms of a stroke. MIHS and Mayo collaborate to evaluate and treat patients, with the hope of reducing their stroke-related disability and sending them back to their home environment because of expedient stroke care.
"We are excited to be part of this collaboration on behalf of patients in Arizona. Thanks to the gift from the benefactor, 24/7, comprehensive telestroke expertise can maximize patients' chances for a good outcome after acute stroke," says Bentley Bobrow, M.D., Maricopa Medical Center Emergency Department.
The Remington family, because of their generous donation, are credited for setting in motion the processes required to start and sustain the telestroke program. Remington became familiar with Mayo's program after being seen by Dr. Demaerschalk. In addition to supporting the Heartland Regional Medical Center in St. Joseph, half of his gift will go toward expanding and sustaining the Arizona telestroke network serving Parker and MIHS.
Dr. Demaerschalk explains that telestroke robot technology is not intended to replace face-to-face communication with patients. "But our research strongly suggests that the technology can enhance evaluation and treatment for patients in rural areas, as well as peer-to-peer collaboration among physicians," he says.
It is estimated that more than 45 percent of Americans live more than 60 minutes away from a primary stroke center. If a stroke has occurred, "every minute is precious," notes Dr. Demaerschalk.
Click here to watch a video of Dr. Demaerschalk and Dwight Channer discussing telestroke.
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