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Myself with our Teleneurology Station in our Emergency Department

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Telemedicine can be described as medical care that is delivered through phone or video capabilities. The earliest use of telemedicine began in the 1940’s but as technology has rapidly expanded our access to live face to face interaction through internet and broadband capacities, telemedicine is becoming a new way of performing medicine in many areas (Wechsler, 2015).  With strokes being a time sensitive issue and the window of administering rTPA being hours from the onset of symptoms, time sensitive neurological care in imperative. Currently there is a lack of neurologists and neurological care at many hospitals, especially those in small rural communities.  The most common form of Teleneurology consists of a moveable cart, with a pan-tilt-zoom camera with a liquid crystal display (LCD) screen, video codec/computer in the patient’s room (Wechsler, 2015). Teleneurology, although mostly used in the emergency room setting for evaluation of stroke patients is now being implementing in treating patients with other neurological disorders both inpatient and outpatient settings.

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rTPA administration has increased since hospitals began using Teleneurology capabilities. Earlier treatment with rTPA allows the probability for a greater outcome and it was shown that those treated by telemedicine have similar outcomes to those who were treated in person (Wechsler, 2015).

Teleneurology is being expanded to treat other disorders such as multiple sclerosis, epilepsy, headache, dementia, Parkinson’s disease, and post-traumatic stress disorder (Wechsler, 2015).

May be less expensive that onsite neurology to provide continual coverage (Wechsler, 2015).

Allows patient a rapid evaluation by a neurologist when time is crucial.

Provides neurological services to patients in rural and underserved areas.

Reduced travel time, reduced costs, and improved care to immobilized patients (Mutgi, Zha & Behrouz, 2015).

Portable systems that allow use throughout the hospital with ease

Gives a unique opportunity for interaction between highly trained neurologists with providers in emergency medicine, urgent care, primary care, and non-neurological specialties to have educational and mentoring relationships (Wechsler, Tsao, et al., 2013).

Empowers the providers at hospitals to be more proactive in care with support of a neurologist.

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The evaluating neurologist is not at the bedside and cannot evaluate tone, sensation, and strength. Another provider needs to be at the bedside to assist with the evaluation.

Limited reimbursement by insurers. Some insurance companies will only reimburse for services provided in person and Medicare restricts reimbursement to those outside of a metropolitan area within a health professional shortage area (Wechsler, 2015).

Costs associated with continually updating technology to upkeep Teleneurology.

Teleneurology providers must be licensed in the state in which the patient they are providing care to is in at the time of service which may require multiple state licenses (Wechsler, 2015).

Liability issues associated with malpractice from recommendations from teleneurology consults.

Lack of hands on assessment from teleneurologist which can make the tele-provider seem more cold and disconnected.

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Brandon: Brandon is a believer and excels at execution. He is responsible and ethical. He will take ownership and believes that expanding our patient care by providing neurological services is at the best interest for the community we serve. Since Brandon believes in our project, he will work with purpose to achieve his goals.

Carter: Carter is a communicator and will be a crucial member to our team. He will work with our physicians and staff to present our plan of execution and clear any miscommunications on the unit. Since Carter excels in communication, he will be the point person to any staff who have questions or concerns to be addressed by the rest of the team.

Isabelle: Isabelle is an includer and is gifted in relationship building. She will help bring the patients, families, and staff along this new process and make them feel included and well cared for. She is engaging and has the patients best interest at heart.

Pablo: Pablo is gifted in positivity. He and Isabelle work great together because they both excel in relationship building. Pablo always has an upbeat attitude that spreads to those around him. His positivity and encouragement will be imperative to keep staff morale high as we implement new changes. Anytime there are changes on the unit, negativity can follow so we chose Pablo to bring energy and optimism to the ED team.

Rose: Rose is a relator. She is caring, trusting, and works well with others. She finds satisfaction when she works hard within a team to achieve a goal. Allowing her to work closely with our ED staff, patients, and family will benefit our patients, families, and staff because of her ability to build relationships.

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The hospital I am employed at became a primary stroke center in December of 2016 when we first implemented Teleneurology in our Emergency Department (ED). In the beginning I was skeptical of how this technology would serve the patients that come through our doors. However, I have been more than pleased with the program we use. Our ED numbers only continue to climb as our community around us is booming with growth. With only two attending neurologists on staff at our hospital, who have busy private practices, it is not feasible for them to come to the ED for every code stroke that comes through our doors. Teleneurology has allowed our patients to have an immediate evaluation from a neurologist with recommendations for treatment for the patient. With administration of rTPA we have been able to provide the best care for our patients without the delay of a transfer to another stroke center. The face to face interaction with the patients through the screen at their bedside has been praised by our patients and their families. In my opinion, I see more confidence in our ED providers and less reluctance to give rTPA when there is a neurologist agreeing with their judgement. Teleneurology also empowered us to keep more patients in our hospital instead of transferring to a larger hospital for an evaluation by another neurologist. Although we do not provide care for hemorrhagic strokes, or have neurosurgical capabilities, we have been able to better serve our community with Teleneurology and becoming a primary stroke center.

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https://jamanetwork.com/journals/jamaneurology/fullarticle/2089220
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3590056/
http://n.neurology.org/content/84/22/e191.short

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Sunil A. Mutgi, Alicia M. Zha, Reza Behrouz. Emerging Subspecialties in Neurology: Telestroke and teleneurology. Neurology Jun 2015, 84 (22) e191-e193; DOI: 10.1212/WNL.0000000000001634
Wechsler L. R., Advantages and Limitations of Teleneurology. JAMA Neurol. 2015;72(3):349–354. doi:10.1001/jamaneurol.2014.3844Wechsler, L. R., Tsao, J. W., Levine, S. R., Swain-Eng, R. J., Adams, R. J., Demaerschalk, B. M., … For the American Academy of Neurology Telemedicine Work Group. (2013). Teleneurology applications: Report of the Telemedicine Work Group of the American Academy of Neurology. Neurology, 80(7), 670–676. http://doi.org/10.1212/WNL.0b013e3182823361