Telemedicine Robots Give Time-Sensitive Stroke Care

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Hospitals are starting to use telemedicine robots to extend the reach of specialists who are not available onsite. These robots are particularly useful in time-sensitive situations, such as when patients suspected of having had strokes arrive at the emergency room.

Thomas Jefferson University Hospital in Philadelphia, for example, has been using a robot from InTouch Health since 2010 to help care for stroke patients. Jefferson's neurologists are now doing stroke consults via robots in 22 community hospitals (another three will come on board soon).

Pamela Kolb, vice president of clinical and support services at Jefferson, told InformationWeek Healthcare that the academic medical center had been aware for some time that local hospitals had difficulty finding neurologists to cover their emergency departments. Some facilities have neurologists on staff, she noted, "but their response can vary radically. Other hospitals have no neurology coverage."

Using robots to enable Jefferson's specialists to do remote consults, Kolb said, "seemed a logical thing for us to do, because we have the expertise here, and we have a very large stroke team. We felt there was a need for better stroke care in the community."

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When someone has a stroke, it's essential that the patient be assessed and treated rapidly to prevent death or serious complications. If the patient shows up at a community hospital that has no expertise in stroke care, she or he is likely to be transferred to a larger institution. The treatment delay can make a big difference in the patient's outcome. So telemedicine offers the ability to improve the quality of care.

The InTouch robot is essentially a rolling machine topped by a video monitor. A physician sitting in a remote location can direct the robot to go to a patient's bedside. Then the offsite physician examines and communicates with the patient, their family, and their onsite providers.

When a possible stroke victim arrives at the emergency room of a hospital in the Jefferson program, an emergency physician orders lab tests and a CT scan, Kolb said. If the results confirm the diagnosis of stroke, the emergency room doctor can ask for a neurology consult at Jefferson.

"Our physicians are required to respond within 15 minutes of receiving the consult request. That means they beam into the robot and are met by a nurse or a physician at the other facility and have a very brief conversation about the patient, and then they examine the patient remotely. They speak with the patient if the patient is able to speak, or with family members, and make sure the time of [stroke] onset has been established. Then they'll make a recommendation in consultation with the physician at that facility and the patient or the family. If the patient is within the window [of time for treatment] and is eligible, they'll recommend the administration of tPA." tPA is short for tissue plasminogen activator, a drug capable of breaking up blood clots.

The results so far have been positive, Kolb said. Patients and families have accepted the robot readily, because it enables their emergency room doctor to consult rapidly with an academic specialist. Unnecessary transfers of patients to Jefferson have been reduced as emergency physicians have become more comfortable treating strokes. Patients are receiving appropriate care more quickly, and the percentage of eligible patients receiving tPA has greatly increased. Although the national average is about 30%, Kolb said, it's around 90% in the hospitals that use Jefferson's robots.

Now, in response to requests from community hospitals, Jefferson is looking at expanding the program to intensive care units. This application is not like an eICU, where intensivists watch multiple ICU monitors in a command center; it's more like "electronic rounding," said Kolb. So it will require some additional resources and planning. "But we're seriously considering that."

InTouch is not the only company that makes telemedicine robots, Kolb noted. But it claims to be the only firm that has FDA clearance, and she said she has no reason to doubt that. The InTouch robot can be connected to a variety of medical devices, she added, although Jefferson has only tried linking it to a digital stethoscope so far.

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