Partner hospitals see benefit of stroke telemedicine program LionNet
It may be only two-and-a-half years old, but Penn State Hershey’s LionNet telestroke program has made it possible for more than 1,600 stroke patients to get lifesaving care close to home.
The regional stroke care network makes it possible for doctors in area emergency departments (EDs) to consult with Penn State Hershey specialists for faster diagnosis and treatment of strokes.
Partner hospitals connect with Penn State Hershey experts through real-time audio and video, allowing patients, family members, doctors and nursing staff to communicate with neuroscience specialists at Hershey as if they were standing in the same room, even though they may be miles away. Records and images are sent and viewed almost instantaneously.
When patients come to an ED with suspected stroke, they need immediate evaluation by a specialist who confirms the diagnosis and makes treatment recommendations, yet many community hospitals may not have neurologists and neurosurgeons available all the time.
Dr. Ray Reichwein (’91), co-director of the Penn State Hershey Stroke Center, said administration of the clot-busting intravenous tissue plasminogen activator (known as IV tPA) must be done within three to four-and-a-half hours of the onset of stroke symptoms. The faster it is prescribed and administered to a patient, the better the clinical outcomes.
Yet if administered in the wrong conditions, the drug has the potential to cause a brain hemorrhage, which could be fatal. Many community emergency department doctors do not have the level of comfort and neurological expertise always at the ready to make key treatment decisions. With their added experience, the Penn State Hershey stroke team is able to help make the decision to administer tPA and are more likely to capture tPA candidates that may have otherwise gone untreated. The experts at Penn State Hershey help weed out the small percentage of stroke patients who need transferred to another facility for more aggressive intra-arterial therapy.
“Use of this technology keeps 80 percent of patients at hospitals where their doctors, medical records and family are – it helps them stay in their community,” Reichwein said.
Mount Nittany Medical Center in State College is the only hospital for 30 minutes in any direction. When a person has a stroke, the amount of time between onset of symptoms and treatment makes a huge difference in the amount of brain damage and speed of recovery.
Susan Maynard, stroke nurse coordinator at Mount Nittany Medical Center said nearly double the number of stroke patients at Mount Nittany Medical Center received IV tPA this year as compared to last year. The amount of time from arrival to administration of the drug has decreased from an average of 81 to 72 minutes in 2014. And the number of cases where the drug was administered within 60 minutes more than doubled as well.
“These might not sound like huge numbers, but they indicate a significant improvement in patient care,” she said.
Since the LionNet program started in 2012, the number of stroke patients network-wide receiving IV tPA has climbed to 29 percent, which LionNet nurse coordinator Morgan Boyer said is an excellent rate for any facility that administers the drug. The national average rate for IV tPA continues to be less than 10 percent.
The number of patients who needed to be transferred from their local hospital for more advanced care dropped from 30 percent to only 12 percent, which shows more patients are able to receive a diagnosis and treatment by experts faster and closer to home. The education and support provided to the hospitalists at partner hospitals has made them more comfortable keeping patients.
LionNet began in July 2012 to ensure that stroke patients received timely expert evaluation and treatment, regardless of which hospital they went to. It also coincided with state legislation mandating that emergency medical personnel could take prospective stroke patients only to certified stroke centers. Many smaller hospitals did not have the resources to become certified, so they would be bypassed, creating a delay in treatment for patients.
To be certified, hospitals must show that they have the ability to do a rapid evaluation and make treatment decisions in the emergency department, said Kelly Rotondo, DNP, RN, LionNet program manager.
“Without support from a network like ours, many cannot do that,” she said. “With more people having strokes today, this technology helps to make sure that they get the right care, at the right time, in the right place.”
The program has grown quite a bit since the first days, with Wilkes-Barre General Hospital signing on to participate in the program in December 2014 and the Regional Hospital of Scranton this January. The Lock Haven Hospital is expected to join the network in early spring 2015, which will bring the number of partner facilities to 14.
“Just by word of mouth, additional sites have contacted us,” Reichwein said. “We now have a waiting list of hospitals seeking to join the LionNet network.”
Most of the partner hospitals, such as Good Samaritan in Lebanon, also use the program to assess patients in the hospital as well as in the emergency department.
“If someone exhibits acute symptoms, we go ahead and call a stroke alert just like we do in the ED,” said
, director of Good Samaritan’s cardiovascular service line. “It is really helpful from a clinical standpoint to have that relationship and bedside expertise. It has given us the collaborative confidence to do the right thing.”
As part of the telestroke program, Penn State Hershey doctors and nurses meet quarterly with medical personnel at partner hospitals to review data and discuss how to improve care by process improvement, and by educating emergency department and EMS providers, as well as the community at large.
Penn State Hershey is certified as a comprehensive stroke center, which means it must engage in professional support to advance healthcare in the region. “One of the ways we do that is through telemedicine,” Rotondo said. “It not only builds relationships, but also improves the stroke care provided at small community hospitals.”
By Jennifer Vogelsong
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