Telestroke service to link specialists to rural centres

Driven by an Ontario-wide shortage of neurologists and the need for speedy diagnoses of stroke patients, a telemedicine program is sweeping across the province.

Soon, Telestroke will link Ottawa experts with patients who live in rural regions of eastern Ontario, allowing two-way real-time

videoconferencing and the electronic transfer of CT images, said Kathryn Crone, program director of CareConnect, prior to her Wednesday presentation entitled Telemedicine Demands in Eastern Ontario at the Children’s Hospital of Eastern Ontario.

An ongoing Telestroke project has already linked Sudbury General Hospital and North Bay General Hospital with stroke specialists in Toronto Western Hospital and Sunnybrook and Women’s College Health Sciences Centre. The project is overseen by NORTH Network, one of CareConnect’s partners based at Sunnybrook.

In a January report, the NORTH Network team said that having a rotation of specialists electronically available on a 24-7 basis was a viable solution for providing care to stroke patients in “under-serviced” communities, such as northern communities that typically lack neurologists.

Treatment of ischemic strokes, which occur when a blood clot lodges in the brain and denies it oxygen, require clot-busting agents such as t-PA. But t-PA has to be administered within three hours of onset and a CT scan of the brain must be read by a specialist.

Increasing treatment speeds for remote stroke victims is key because the longer it takes to diagnose a stroke, the greater the neurological damage and the more brain function that could potentially be lost.

“How do we make sure everyone gets access to this very time-sensitive intervention? That was the challenge, and Telestroke seemed like the obvious answer for some parts of the province,” said Mary Lewis, senior manager of government relations at the Heart and Stroke Foundation of Ontario, a partner in the project.

Crone wishes to reproduce the Telestroke model in eastern Ontario and take part in province-wide rollout of the initiative. Such a rollout would mean equipping more remote emergency centres with portable stroke “carts” that include teleconferencing equipment, high-quality video cameras, television monitors, microphone and electronic stethoscopes.

“We’re working with the Heart and Stroke Foundation and the Ministry of Health (and Long Term Care) to see if we can roll this out provincially,” said Crone. “The ministry leads are working closely with us on how we can have provincial collaboration.”

Key to this collaboration is the partnership currently maintained between CareConnect, NORTH Network and the VideoCare telemedicine team, which is based in the London Health Sciences Centre. Together, these groups form the Telemedicine Networks of Ontario.

But before an Ontario-wide rollout of Telestroke occurs, “we need to make sure we have the right technology in the right places, and we need to make sure people are trained, and that we have a secure private network and network support”, said Crone.

“We’re in the process of putting this all together now.”

Karen Waite, manager, special projects at the NORTH Network, a program of Sunnybrook and Women’s College Health Sciences Centre, said the bulk of the work to get the first northern pilot site up and running comprised of harmonizing the clinical protocols among all the organizations. In addition, work entailed setting up technology to support both the image exchange for CT images and the two-way videoconferencing.

“Lessons learned through the NORTH Network pilot can be applied to other communities,”” she said. But decisions around which support model to use for any provincial rollout is still at the preliminary stages and funding has yet to be finalized, she added.

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