Time is of the essence when treating stroke patients. By using telemedicine, emergency physicians have been able to evaluate a patient for acute stroke and administer tPA treatment within 25 minutes, according to Mark McLean, MD, FACEP, emergency department medical director, Maury Regional Medical Center, Columbia, Tenn, and medical director of TeleHealth for TeamHealth.

“During that time a physician examines the patient, the patient gets a [CT] scan, a teleneurologist reads the results and performs an exam with the National Institutes of Health’s stroke scale, and lab tests are done and reviewed,” Dr. McLean said. “All of this could not be done this quickly if we had to wait for a community neurologist to arrive and assess the patient.”

Approximately 3,500 US medical institutions participate in an estimated 200 telemedicine networks.

Telemedicine is used in a variety of applications and services.In acute care, most telemedicine consultations are done via Internet, phone, or mobile devices such as a tablet or smartphone, said Alan Roga, MD, FACEP, chief executive officer, Stat Health Services, the providers of Stat Doctors, Scottsdale, Ariz.

Approximately 3,500 US medical institutions participate in an estimated 200 telemedicine networks, according to the American Telemedicine Association (ATA). About half of these networks provide patient care services via telemedicine every day. Telemedicine specialists can be located anywhere—their home, an office, or another hospital.

How It’s Used

Jennifer Newton, MD, emergency department stroke director, Saddleback Memorial Medical Center, Laguna Hills and San Clemente, Calif, said the facility started using telemedicine two years ago as a way to improve its acute stroke care. “This has allowed us to improve both our overall tPA rates and door-to-needle times,” she reported.

Treating stroke patients actually tops the list of ways that telemedicine is used. According to Paul Hildebrand, MD, associate director, TeamHealth Patient Safety Organization, Knoxville, Tenn, which provides telemedicine services: “Round-the-clock availability historically has not been a major area of interest for neurologists. Teleneurology fills the need by preventing disruption of office hours with emergency calls, relieving the on-call burden, and providing rapid response to neurological emergencies in places and situations where access would not otherwise exist.” In fact, ATA estimates that, in 2012, close to 100,000 patients went to the emergency department for strokes and were seen by neurologists using telemedicine.

“When a hospital contacts us, we respond within 15 minutes to determine the acuity of the call and then connect a specialist to the emergency room physician,” said Joe Peterson, MD, chief executive officer of telemedicine provider Specialists On Call, Reston, Va. “If a video consultation is required, our mobile telemedicine endpoint is wheeled to the patient’s bedside so our specialist can examine the patient. Within 30 minutes of its conclusion, the hospital receives all written recommendations and documentation for the patient’s medical record.”

Our telemedicine partner provides a callback consultation with the emergency department physician within 15 minutes and bedside exam within 30 minutes—and oftentimes sooner. It allows us to share the job of informed consent, has improved the emergency department physician’s comfort level with administering tPA in appropriate cases, and has allowed us to have face-to-face team discussions about time-sensitive stroke care in real time.—Jennifer Newton, MD

Telepsychiatry is also useful to emergency physicians because the number of patients presenting to emergency departments with mental health issues is growing. “These patients can place an enormous burden on already-busy emergency departments because they are often difficult to manage and observe,” Dr. Hildebrand said. “The shortage of available psychiatric consults or psychiatric beds may cause long waits for appropriate treatment.” Telepsychiatry can expedite the treatment process and improve patient flow by allowing for diagnosis and assessment, medication management, and group therapy by a consulting physician.