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BISBEE — “Telemedicine is the future of medicine in rural areas,” asserts Jim Dickson, chief executive officer for Copper Queen Community Hospital. “And now we’re expanding our virtual healthcare services.”
Working collaboratively with Mayo Clinic in Arizona, the hospital will soon be utilizing telemedicine to deliver quality care to acute stroke victims. Through an innovative system called Stroke Telemedicine for Rural Residents, or STARR, the hospital’s emergency department will have the ability to communicate with some of the state’s top neurologists when treating patients suffering from strokes.
“It’s estimated that fewer than 2 percent of all stroke patients in Arizona’s remote areas are getting the treatment they need within the three-hour recommended window,” said Dr. Bart Demaerschalk, director of the Cerebrovascular Diseases Center and consultant for the Department of Neurology at the Mayo Clinic Phoenix campus.
Because of that window, Demaerschalk says it’s almost impossible to transport stroke victims long distances, in time to receive optimum benefit from the treatment.
 Dr. Bart Demaerschalk, with Mayo Clinic in Phoenix, talks about the new stroke telemedicine system that will be installed at the Copper Queen Community Hospital in Bisbee. (Ed Honda-Herald/Review) |
Demaerschalk was in Bisbee on Monday to talk to CQCH staff and media about the STARR system, which the hospital expects to have up and running in December.
The system has been in place at Yuma Regional Medical Center and Kingman Regional Medical Center for nine months as a pilot project. One hundred patients have been treated with the audiovisual, two-way telemedicine system with promising results.
“We have had very positive outcomes,” Demaerschalk said. “In the past nine months, we’ve received 100 calls, 50 from each hospital. Complication rates have been low, and the patients have had excellent results.”
Through the STARR system, local physicians call a Mayo Clinic stroke hotline and are given immediate access to one of the clinic’s four vascular neurologists. The two-way, audiovisual technology allows the patient to see and hear the Mayo physician hundreds of miles away.
The physician conducts an emergency consultation by taking the patient’s history and conducting a virtual examination.
After reviewing brain scans and other tests, the physician determines the extent of the patient’s neurological deficit and makes treatment recommendations.
Mayo Clinic in Arizona is the state’s first medical facility to pioneer a clinical research study using telemedicine as a means of serving stroke patients in remote locations.
Two Mayo Clinic doctors, Demaerschalk and Dr. Bentley Bobrow are the program’s co-directors and co-principal investigators.
Demaerschalk is board-certified in both neurology and vascular neurology.
Bobrow is board-certified in emergency medicine.
In addition to Demaerschalk, there are three other doctors with board certifications in neurology and vascular neurology involved in the telestroke program at Mayo Clinic.
Those doctors are Maria Aguilar, Tim Ingall and David Dodick.
The telestroke network is designed to alert a Mayo Clinic doctor in five minutes.
“From notification to the collaborative treatments, it takes about 30 minutes to start treatment,” Demaerschalt said.
“This technology provides an opportunity to interact with the patient, which is one of the most important features of this program,” Demaerschalk said. “We’re able to ask patients how they’re doing, along with seeing the vital signs and CAT scans. As we practice in this manner, we feel as though we’re right there at the foot of the patient’s bed.”
Treatments can include the time-sensitive administration of a clot-busting drug, tissue plasminogen activator, or TPA. Eligible stroke patients seen within the three-hour time period are given the medication and then transported to a stroke center for continuing therapy, if transport is deemed necessary.
“Once this system is in place, one of our goals is to allow the patient to stay in the community for follow-up care,” said Dr. Sayed Azam, chief of staff at CQCH. “Right now, patients are referred to Tucson for stroke treatment and follow-up care. This new system will allow most of our stroke patients to stay right here and continue care with their physician.”
Based on patient outcomes in Yuma and Kingman, fewer than 10 percent of the acute stroke victims have to be transported to another facility for further care. Ninety percent are managed adequately in their own community.
In an effort to provide stroke patients with full rehabilitative services without having to travel out of the of the area, CQCH recently added Lisa Cummings to its staff, an occupational therapist who also serves as director of the hospital’s rehabilitation program.
CQCH’s telemedicine programs, Azam said, have helped to bridge serious physician shortage gaps, felt especially hard when it comes to specialties.
To date, the hospital has implemented teletrauma, teledermatology and home health telemonitoring programs. Along with the telestroke system, the hospital has future plans for implementing a telecardiology program.
Dr. Theresa McEntee, a long-time Bisbee physician, will be heading the hospital’s telemedicine programs.
“It is the hospital’s mission to provide access to primary and tertiary care,” McEntee said. “We see telemedicine as the most immediate answer to the physician specialist shortage felt throughout Arizona, but is most critical in rural communities.”
Funded by the Arizona Department of Health Services, the initial telestroke study, called the STRokeE DOC Arizona trial, is nearing completion. The trial started in Yuma and Kingman in December 2007.
“We were made aware of an Arizona Department of Health Services grant to create a telestroke program through Mayo Clinic and immediately approached them about getting on board,” Dickson said. “Mayo Clinic has one of the best neurology programs in the state, so when they agreed to make CQCH their next implementation site, we were thrilled. This program is another method for bringing quality care to the community, while moving toward becoming a virtual medical facility.”
Community outreach
In an effort to teach the community the importance of recognizing stroke symptoms and getting seen immediately when symptoms of a stroke occur, Copper Queen Community Hospital will be launching a public education program.
The faster a patient is treated for stroke, the better the person’s outcome.
The five symptoms are:
• Half the body is paralyzed or weak, along with numbness.
• Difficulty speaking.
• Vision is blurred, sometimes double vision occurs.
• Sudden, severe headache.
• Dizziness, with loss of balance and difficulty walking.
Some stroke victims experience all five symptoms, while others will have isolated symptoms.
Herald/Review health reporter Dana Cole can be reached at 515-4618 or by e-mail at dana.cole@svherald.com.
Ira Woolery wrote on Sep 16, 2008 9:10 AM: