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When it comes to saving a stroke-affected brain, every minute counts.
That's why an emergency telemedicine program is revolutionizing health
care for people living in remote communities in Northern Ontario. It's
reducing the chance of disability and improving the quality of life
for many Canadians.
The idea is simple: With the help of two-way video conferencing equipment,
stroke patients in northern communities are transported to within electronic
reach of a specialist in a Toronto hospital. From a console hundreds of
kilometres away, a neurologist can talk to the patient or the patient's
family, review the computerized axial tomography (CAT) scans of the brain,
administer neurological tests or advise the attending emergency-room physician
on the treatment.
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Telestroke pilot project takes off in Northern Ontario
Patients in North Bay and Sudbury are the first to test drive the Canadian Stroke Network's Telestroke care model. The Canadian Stroke Network provided $630,000 in funding toward program start-up costs, with the Ontario Ministry of Health and Long Term Care and the NORTH Network financing the balance.
The NORTH Network provides medical specialist consultations for patients and health education for health professionals in over 70 rural and remote areas of Ontario, using live, two-way videoconferencing and electronic medical devices to diagnose and treat patients. The network currently conducts close to 500 clinical consultations and about 100 educational events monthly.
Hospitals in North Bay and Sudbury are already providing this service, with more sites being planned. To date, a total of 15 consultations have been completed, with three going on to receive a tissue plasminogen activator, or clot-busting medicine. Volumes will increase as a public campaign raises the awareness of signs and symptoms of stroke, as well as the urgency of seeking medical attention at the appropriate health-care facility.
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"The longer it takes to diagnose and treat a stroke, the more brain function is likely to be lost," says Dr. Frank Silver of the Canadian Stroke Network, a national organization that links stroke experts across the country. "Telestroke offers a unique way of sharing specialized care in areas that don't have a full complement of sub-specialists."
Clot-busting drugs used to treat strokes are relatively new and must be administered within three hours after the first symptoms appear. That gives a neurologist little time to examine the patient's scan and conduct a neurological exam. The situation is particularly critical for people living in rural areas, where there are few neurologists.
Telestroke offers a solution. Remote emergency rooms use portable videoconferencing units equipped with a high-quality camera and a microphone to contact an on-call stroke expert. The northern patient is connected to a neurologist at the neurologists' home or at a hospital-based videoconferencing workstation and treats the patient "virtually" in collaboration with the attending emergency-room physician.
The program is supported by NORTH Network's round-the-clock help desk, a web-based physician-on-call roster and regular virtual rounds to facilitate learning among health-care professionals. Telestroke also has an ongoing evaluation component to examine clinical outcomes and patient and provider satisfaction.
"We want to help more people walk away from a stroke," says Dr. Silver. "Through initiatives such as Telestroke, the Canadian Stroke Network is working to reduce the impact of stroke, which is the number-one cause of adult disability in Canada."
In addition to acute care, telemedicine makes it possible to follow up with patients who have returned to their rural homes after treatment, saving patients and doctors the time and cost of travel. "It will provide northern residents with access to care previously available only to those living in urban centres," says Dr. Silver.
Telestroke is the first initiative of its kind in Canada, and one that is poised to make a real difference in the lives of those living in northern communities.
www.canadianstrokenetwork.ca
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