SEATTLE, Nov. 14, 2007 – On October 22 Swedish became the first hospital in western Washington to activate an advanced telemedicine system in the emergency rooms (ER) of its Issaquah and Ballard campuses to provide a real-time, 24/7 link between ER physicians and stroke specialists based at the Cherry Hill Campus, where Swedish’s nationally recognized Stroke Program is based.
The Swedish TeleStroke Program is part of an integrated effort to improve stroke diagnosis and treatment throughout Washington state. It is modeled after the country’s first and leading program at Massachusetts General Hospital (MGH), a founding member of the Partners HealthCare System in Boston.
Through a secure videoconferencing network, Swedish’s Stroke Program is able to provide real-time, expert assessment of patients arriving with stroke-like symptoms. Around the clock, stroke specialists based at Swedish/Cherry Hill are able to perform “virtual” bedside neurological evaluations during which they are able to examine patients, review brain images and quickly select the best acute stroke treatments in collaboration with local ER staffs.
Stroke is the third largest cause of death and a leading cause of serious, long-term disability in the United States. According to the American Stroke Association, about 700,000 Americans suffer a new or recurrent stroke each year. That means, on average, a stroke occurs every 45 seconds and about every three minutes, someone dies of stroke.
Closer to home, Washington state has the sixth highest rate of stroke deaths in the country. Fortunately, over the past decade stroke care has improved in various ways. Examples include newer diagnostic tests that are available to help pinpoint the location of a clot, and newer therapeutic treatments that may help reverse or minimize the impact of a stroke. However, these treatments are time-dependent and, as a result, most effective when they can be provided in the nearest emergency room. Unfortunately, many ERs do not have the volume or support to provide American Heart Association-recommended stroke evaluations and treatments. Telemedicine provides an effective way of bringing to the patient’s community ER the same level of expert care available at a major medical center with an experienced stroke program.
How the Swedish TeleStroke Program Works
The Swedish Stroke Program hub is located in the James Tower on the Cherry Hill Campus in Seattle. When a rescue candidate stroke patient arrives in an ER at any time of the day or night, the Swedish stroke team is paged. As indicated, members of the team – which include a stroke physician in coordination with a specially trained stroke nurse practitioner/physician or Registered Nurse – can log in on their home or office computers to complete a TeleStroke examination and determine if a patient might qualify for available rescue therapies in an attempt to ‘stop’ the stroke. The most common rescue therapy that the stroke team would use is an FDA-approved medicine called tissue plasminogen activator or tPA. This medicine can reverse the devastating effects of stroke for some patients if it is administered within three hours of the onset of a stroke. But the key to the successful use of tPA – or other clot-busting thrombolytic drugs – lies in rapid and correct diagnosis because as every minute passes, more brain cells die if the blood clot causing the stroke is not destroyed (“Time is Brain”).
“All four Swedish campuses – First Hill, Cherry Hill, Ballard and Issaquah – are certified as Primary Stroke Centers by the Joint Commission for the Accreditation of Healthcare Organizations,” said William Likosky, M.D., medical director of the Swedish Stroke Program. “TeleStroke is another important tool in our arsenal against the third leading cause of death in the United States and the number-one cause of adult disability.”
MGH clinicians provided software and TeleStroke implementation support to Swedish over the past several months. In preparation for phase one of the project – in which Swedish implemented TeleStroke support for its Ballard and Issaquah campuses – a total of 14 Swedish Stroke Team clinicians were trained on the TeleStroke system, primarily via videoconferencing. That group included seven neurologists, three nurse practitioners, one physician assistant, and three registered nurses. In addition, the ER staffs at Swedish’s Ballard and Issaquah campuses have been trained in the use of this TeleStroke equipment.
Since 2003, doctors with the Partners TeleStroke program have provided more than 167 video consults to affiliated hospitals – and another 239 evaluations based on telephone links. TeleStroke consultation also ensures that high quality, in-hospital and post-acute interventions are in place to prevent recurrent stroke and future disability.
“We chose to partner with MGH because they are one of the national leaders in implementing telemedicine for stroke,” said Tammy Cress, R.N., Swedish Stroke Program manager. “They have been doing this for about 10 years and it makes little sense for anyone to reinvent the wheel when advanced stroke therapy is needed in so many parts of the country right now.”
“I am delighted and gratified to be able to share our knowledge about the TeleStroke Program with Swedish,” said Lee Schwamm, M.D., director of the Partners TeleStroke Program and the MGH Acute Stroke Service. “After years of experience helping stroke patients through this telemedicine program in Massachusetts, it is exciting to be able to help even more patients by expanding this successful program to other parts of the country.”
Clinicians at other Puget Sound-area medical centers may be able to become part of this TeleStroke network, which would also include the option to participate in learning opportunities broadcast over the Partners TeleStroke network and in multi-site clinical research projects.
The technology costs for phase one of the Swedish TeleStroke Program amounted to less than $100,000, which was entirely funded by the Swedish Foundation and its generous donors. The Swedish Foundation is now in the process of raising funds to support subsequent phases of the program.
To view video clips of actual TeleStroke-enabled anylyses being performed, click here.
For more information on Swedish’s TeleStroke Program or advanced stroke diagnosis and treatment, contact Tammy Cress at 206-320-3112 or via firstname.lastname@example.org
Swedish is the largest, most comprehensive, nonprofit health provider in the Greater Seattle area. It is comprised of three hospital campuses (First Hill, Cherry Hill and Ballard), a freestanding emergency room and specialty center in Issaquah, Swedish Home Care Services and Swedish Physicians – a network of 12 primary-care clinics located throughout the Puget Sound region. In addition to general medical and surgical care, Swedish is known as a regional referral center, providing specialized treatment in areas such as cardiovascular care, cancer care, neuroscience, orthopedics, high-risk obstetrics, organ transplantation and clinical research. For more information, visit www.swedish.org
About the Swedish Neuroscience Institute
In 2004, Swedish expanded its neuroscience services by establishing the Swedish Neuroscience Institute. The team of leading neurosurgeons and other specialists are building a world-class institute dedicated solely to the treatment and advancement of neurological disorders for patients in the Pacific Northwest and around the world. Swedish/Cherry Hill has been designated as the hub for the Institute and has been upgraded with four state-of-the-art operating rooms featuring intra-operative MRI, CT scanning and neuro-interventional radiology capabilities; a renovated neuro intensive-care unit; and a CyberKnife® facility for radiosurgical treatment of tumors throughout the body. SNI specializes in the research for and treatment of stroke; cerebral aneurysms and arteriovenous malformations; movement disorders such as Parkinson’s disease and tremors; brain tumors (including both malignant tumors and benign tumors such as meningiomas); neuro-endocrine disorders including pituitary tumors; epilepsy; child neurological disorders; neuro-ophthalmology; headaches; multiple sclerosis and many other neurological conditions and diseases. In each category, physicians from different specialties are brought together to provide a multi-disciplinary approach centered on providing top-notch patient care. For more information, visit www.swedish.org
About the Massachusetts General Hospital
Founded in 1811, the MGH is the third oldest general hospital in the United States and the oldest and largest in New England. The 900-bed medical center offers sophisticated diagnostic and therapeutic care in virtually every specialty and subspecialty of medicine and surgery. Each year the MGH admits more than 46,000 inpatients and handles nearly 1.5 million outpatient visits at its main campus and health centers. Its Emergency Department records nearly 80,000 visits annually. The surgical staff performs more than 35,000 operations and the MGH Vincent Obstetrics Service delivers more than 3,500 babies each year. The MGH conducts the largest hospital-based research program in the country, with an annual research budget of approximately $500 million. It is the oldest and largest teaching hospital of Harvard Medical School, where nearly all MGH staff physicians serve on the faculty. The MGH is consistently ranked among the nation’s top hospitals by US News and World Report. For more information, visit www.massgeneral.org