Holly Carlson's Story (Jefferson Healthcare)
Building a health-care bridge across Washington
It was a typical August day for 44-year-old Holley Carlson. She completed her five-mile run early in the morning, downed a protein shake, and headed into her real estate office in Port Townsend. Although she didn’t feel quite right and worried she might be getting a migraine, she showed a client a few houses. Late in the afternoon, while reading a listing to another client, she realized her words weren’t making sense. When she got home and told her husband about the incident, he urged her to go to the hospital. She agreed to do so if she wasn’t feeling better in the morning. Just a few hours later her body went limp and she collapsed. At the emergency room at Jefferson General Hospital, Holley underwent a battery of tests. The initial determination, based on test results and the absence of any atherosclerosis risk factors (e.g., diabetes, hypertension, smoking), was at least a 70 percent blockage of the carotid artery and a possible dissection. Holley was transported to Swedish Cherry Hill, where the neurologist discovered a two-inch dissection causing a 95-percent-blocked carotid artery. Her condition required a lengthy angiogram to place four stents.
Although she has had to give up running and swimming, Holley was lucky. Jefferson and the Swedish Stroke Center had recently launched an enhanced partnership to better manage stroke patients in her small community. After two years of discussions, key players from Swedish, representatives from Port Townsend’s EMS, personnel from Jefferson’s emergency, acute care and ICU, lab and radiology departments, and Pacific Vascular (Jefferson’s ultrasound provider) came together in January 2008 for a four-day work session. This team developed new, streamlined protocols for handling stroke patients and launched a two-month education and awareness program.
“We are closely monitoring how well the new protocol is working,” says Terri Camp, RN, MHL, chief quality officer and chief nursing executive at Jefferson Healthcare. “I am pleased we have been able to get the decision-making information we need (CT, labs, etc.) within our established 45-minute-from-arrival goal. We recently implemented a huddle immediately after a Code Stroke, so the team can evaluate how things went and identify improvement opportunities.”
The first phase of the relationship relied on telephone consults while information technology and radiology personnel from Jefferson and Swedish built the infrastructure and tested the videoconferencing and brain imaging transfer equipment to ensure a consistent and reliable connection. Following two dry runs with simulated patients, the Swedish stroke telemedicine program at Jefferson launched in mid-December.
“The relationship and video-conferencing capability with Swedish,” says Gunther Muens, M.D., emergency room medical director at Jefferson, “allows us to evaluate patients in our emergency room, determine what we can do here, and ensure only appropriate patients are transported to Swedish. We also benefit from access to educational resources, shared guidelines and protocols, and improved access to beds in Seattle, which had been a challenge that sometimes delayed treatment for our patients.” This conscientious use of limited resources is beneficial for Jefferson and Swedish, and for the patients.
“Our demographics suggest we will see increased numbers of patients who fit the risk criteria for stroke,” says Vic Dirksen, CEO of Jefferson Healthcare. “With the old model, we often transported patients who didn’t really need to go to Swedish. This wasn’t a good use of Swedish resources, nor was it good for the patient’s family who incurred a hefty bill for the helicopter ride and faced personal challenges trying to be near their hospitalized loved one.”
Telemedicine possibilities extend far beyond this one specialty. With new protocols, staff training and a reliable connection to subspecialists, emergency room personnel can be more comfortable determining which patients do or do not need the added level of care available only at medical centers, such as Swedish. Dirksen believes this type of partnership is the future of medicine.
“Originally, I thought health-care reform would come about only because of increasing costs,” says Dirksen. “Now I believe reform will come as a response to the nationwide physician-workforce shortage and the imperative to find creative solutions that bring subspecialty expertise to communities such as Port Townsend.
I am thrilled we were able to work with Swedish in a constructive way that met all regulatory requirements because it makes so much sense for communities across the state.”
Both Muens and Dirksen see the Swedish Stroke Telemedicine Program as the first step in building a health-care bridge not only across Puget Sound, but across the state.