The Tele Stroke network in NSW is not only enabling more people in regional areas to receive treatment within the ‘golden hour’, it is also providing valuable research data, according to medical director Professor Ken Butcher
The Director of Clinical Neurosciences at the Prince of Wales Clinical School , Professor Butcher says the ongoing rollout of the Tele Stroke system is now connecting 12 rural hospitals in virtual meeting with nine metropolitan stroke specialists and the network will expand to 23 hospitals by the end of the year.
He says the NSW Tele Stroke Service has already been used to assess and treat more 1000 patients from regional NSW in the past 12 months, and it has reduced the average time for a patient to receive thrombolysis down to 66 minutes.
“In the past, if someone presented at a regional hospital with stroke-like symptoms, the ED would do a scan and call one of the neuroradiologist doctors in Sydney and then wait for them to tell what the scan shows.
“Then, if necessary, the patient might be airlifted to Sydney – so it could be hours before they get any sort of medical intervention.
“Now the ED doesn’t have to wait for a neuroradiologist in Sydney to make their report. We have a specialist stroke-trained doctor virtually there in the ED room with the doctor and patient. They can see us, we can see them. We can talk to them and know exactly what we’re dealing with – it’s no longer a description over the phone.”
Using high quality cameras, microphones, AI systems, diagnostic scanning and imaging tools all streaming in real time over a high-speed internet connection, the Tele Stroke system allows specialists and ED registrars to work together to quickly determine whether the patient has had a stroke, and if so, decide on the best medical strategy, said Professor Butcher.
It may well turn out that the patient does need transporting to Sydney to see a neuro-interventional radiologist who can remove a blood clot, but in the meantime, the ED can administer thrombolysis drugs that buy the patient valuable time.
Before making the call to bring in the Tele Stroke specialists, the ED doctor enters the patient’s details and symptoms into an online diagnostic tool which provides guidance on next steps in the process. Ringing a 1300 number will connect the ED room with one of nine specialists who collectively are on-call, 24/7.
“In most cases, once the ED registrar has contacted us, the patient is sent for scans and we meet the patient and the physician virtually in the scanning room, and assess the images as they’re taken,” Professor Butcher said.
Using research scans as standard tools
Three different scans are taken of the patient using a CT-scanner: a non-contrast CT scan of the brain to determine the type of stroke the patient has; a CT angiogram to see blood vessels both in the neck and the brain, and a perfusion scan to give a map of regional blood flow.
Professor Butcher said Australia was leading the world in streamlining these different technologies – particularly perfusion imaging – into stroke treatment.
“A lot of people around the world would argue angiogram scans and perfusion scans are for research. But we say in this setting where every minute counts, these scans are critical. We’ve taken what was a research concept and made it a standard tool.”
Nevertheless, with digital technology much of the data collected – including scan images, diagnostic tools and time to first treatment – can still be used in research.
According to Professor Butcher, the Tele Stroke program is being used both for prospective studies of new thrombolytic therapies and also for retrospective research, thanks to the archiving of all source image data.
“If you set up a platform like this, which benefits patients, it also benefits researchers, because you’re collecting the same data in the same fashion all the time, including outcomes. Also, retrospectively, you can see in real time what we’re accomplishing, where the problems are,” he said.
A research paper later is expected later this year that will provide a detailed analysis of the Tele Stroke system in its first 12 months.