Future is now with Swedish/Edmonds’ TeleStroke program

Specialists miles away can look patient in the eye, diagnose and treat
By Paul Archipley | Oct 10, 2013
Kristi Whiton, RN and Stroke Coordinator, and Dr. Todd Czartoski, Director of Neurology, demonstrate how the TeleStroke program works at Swedish/Edmonds.

From early sci-fi to “Star Trek” to the sitcom “The Big Bang Theory,” the idea of virtual presence has been a dream of the future.

But at Swedish/Edmonds, the future is now.

There are health emergencies, such as stroke, in which quick decisions by medical specialists are critical to positive outcomes. But what if a stroke victim is rushed to the nearest hospital, and no specialist is available?

Part of the Swedish TeleHealth Network, Swedish/Edmonds has solved that problem with its TeleStroke program. It ensures that a team at the Swedish Neuroscience Institute in Seattle, including stroke neurologists and specially trained advanced practice nurses and physician assistants, is available 24/7.

And yes, TeleHealth means just what it sounds like: specialists miles away are helping diagnose and treat stroke victims through video conferencing in real time.

A neurologist or other specialist on a monitor can see and talk with the patient, family members and other medical staff, leading to an efficient, collaborative evaluation and treatment.

The doctor on the TV screen can control the camera, zoom in on the patient to look for signs of stroke, conduct an exam of the patient, and turn to talk to others in the room.

Time, as the saying goes, is of the essence.

Dr. Todd Czartoski, the Medical Director at Swedish Health Services’ Telehealth, said there is a shortage of stroke neurologists nationwide.

Swedish/Edmonds has one on staff, but he can’t be in the hospital all day, every day.

“It would be difficult for Edmonds to pay for this kind of service on its own,” Dr. Czartoski said.

“This is an efficient way of seeing a patient quickly.”

Swedish/Edmonds also has a TeleEEG program, and the Swedish TeleHealth Network provides a range of programs, including Tele ICU, Tele Wound, Tele Psychiatry and more.

From a control center hub, specialists can oversee 16 hospitals across the state, Czartoski said.

In the TeleStroke program, medical professionals have standardized evaluations, using a “stroke scale” to diagnose the severity of a patient’s condition and, in fact, whether he actually did suffer a stroke.

It’s an important diagnosis, because stroke victims are often given “clot buster” medication that can save a patient’s life and the possibility of years of suffering and rehabilitation.

But if the patient is misdiagnosed, that medication could cause harm.

Thanks to the TeleStroke program, the danger of misdiagnosis is minimized.

And because Swedish implemented comprehensive electronic medical records in 2007, the medical team – no matter where it’s located – can look at the same information via a secure Internet connection.

Larry Hadland, medical services officer for the Lynnwood Fire Department, said the TeleStroke program gives stroke victims a better chance from the moment paramedics arrive.

EMTs make the initial assessment, but are immediately on the phone to the hospital alerting medical staff of their findings.

Years ago, when he was a paramedic in Los Angeles, Hadland said there was no standard treatment or program, and the outcome was much darker.

“Now, when we call a code stroke, the team is up, ready and waiting,” he said.

“Stroke is truly devastating to the brain. If you can get into the TeleStroke program, you’re potentially saving high costs and, more importantly, your quality of life.”

Czartoski echoed that sentiment. He said the economic impact in Washington is somewhere north of $40 million if patients are treated quickly and saved from severe brain damage.

“What a difference five to 15 minutes make,” Czartoski said.

Stroke specialists have a saying: Time is brain.

“That’s why everything is streamlined,” Czartoski said. “It’s ‘door to needle time.’

“The faster you can treat, the better they’ll do.”

Dr. Brian Chou, an ED physician at Swedish/Edmonds who has been active in launching TeleStroke, said lives have been saved thanks to its implementation.

“Stroke can be difficult to diagnose,” Dr. Chou said. “Having a specialist seeing the patient in real time is so helpful.”

He said giving a patient a tissue plasminogen activator (TPA), or “clot-busting” medication, can be harmful in some circumstances, “so we want to be on the same page.”

“It’s nice to have that other doctor there.”

Patients, Dr. Czartoski said, aren’t batting an eye when nurses wheel in a monitor, a doctor on the screen looks them in the eye and starts talking to them.

Perhaps it was those years of watching “Star Trek” or Sheldon’s decision to become a “virtual presence” to his friends on “The Big Bang Theory.”

In any event, patients can expect more of it down the road.

“The ideal is ‘hands on,’” Dr. Chou said. “But this is the next best thing.

“In certain arenas, it’s going to be the future.”

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