Case Study: Saving lives one videoconference at a time
Linking a rural hospital with a major metro institution is making a difference to stroke treatment in the bush.
The Challenge: Provide access to city-based neurologists for people living in the bush who have had a stroke.
The Approach: Using video conferencing, metro-based neurologists are able to review the symptoms of rural stroke patients and recommend treatment.
The Outcomes: A twenty percent improvement in the number of patients able to return home with a relatively high degree of functionality.
The Lessons Learned: Accessing expert medical help during the four-hour “golden period” significantly improves the outcomes for stroke patients living in the bush.
The Upside for:
Clinicians: Rural doctors are able to access expert advice when it comes to treating stroke patients who present at their facility.
Patients: Patients are able to access the treatment of specialists whose expertise would otherwise be denied to them because of their distance from a major metropolitan facility.
The Organisation: Linking Royal Melbourne and Wangaratta demonstrates technology can make a significant impact, at minimal cost, on the outcomes of a significant illness. The technology used is simple, off the shelf technology.
The Rural Victorian Telestroke Project’s story
The stark reality for country patients is that if they present to a rural hospital with the symptoms of a stroke there’s almost no hope of getting up to the minute treatment.
It was with this in mind that Dr Bernard Yan, together with Les Bolitho, the current president of the Royal Australian College of Physicians, came up with the idea of trialing a video conferencing system designed to give rural stroke patients access to specialist services at a distance.
“We started trialing this service in October 2009, linking together Royal Melbourne Hospital and North East Health Wangaratta,” Dr Yan told eHealthspace.org. “There are two things a patient with acute stroke needs: access to CT or MRI, and access to a neurologist.”
There are around 420 neurologists in Australia, ninety percent of whom live and work in metropolitan areas. Every year 60,000 Australians will experience stroke, a significant number of them in rural and regional areas.
According to Dr Yan there’s a four-hour golden window for treating stroke. Beyond that time there’s little point in treating the patient. “It’s a numbers game,” noted Dr Yan. “Every minute you can’t open up the blocked artery in the brain, the patient loses 1.9 million neurons.” Beyond the four-hour period the patient will either be significantly incapacitated, or will die.
The Rural Victorian Telestroke Project links together Royal Melbourne with Wangaratta using a computer, microphone and webcam. Royal Melbourne has a roster of neurologists on call 24 hours a day, and once a patient presents at Wangaratta with stroke symptoms, the duty doctor can interview them and review the imagery using a laptop or tablet computer. The doctor doesn’t even need to be present at Royal Melbourne to conduct the interview.
The neurologist is then able to recommend treatment for the patient. Generally speaking, the most effective treatment at a rural hospital is the use of an IV medication that dissolves the clot. “It’s a bit like putting draino down a drain to remove a blockage,” Dr Yan explained.
The trial has treated 140 patients, with an improvement of twenty percent in the number of patients who can go back to having a relatively normal life. “It would be nice to get a higher number, but the reality is, as I noted before, it’s a numbers game,” he said. “A third will die, a third will be incapacitated and end up in a support environment, and the remainder will go home with some deficits.”
Stroke isn’t pretty. Patients who have suffered a stroke tend to present at hospital paralysed down one side, or unable to talk. However, the trial has demonstrated that simple technologies can improve the outcomes for patients in rural areas.
Yet Dr Yan remains frustrated, and not just by the fact that treating stroke is a numbers game.
“We would like to expand it to other rural hospitals,” he said. “There’s no reason not to, but we don’t have the funding. The current government telehealth initiative doesn’t cover what we do. In my opinion, the current telehealth initiative is next to useless.”
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