TeleStroke allows faster, better treatment

Hey there, time traveller!
This article was published 20/11/2017 (3057 days ago), so information in it may no longer be current.

Having a stroke in The Pas used to mean irreversible, lifelong damage was almost a guarantee.

Emergency-room physicians could stabilize a patient and prep them for transfer to Winnipeg, but for the most part, the role was one of comfort and symptom management, not treatment.

The ER doctors didn’t have the technical know-how to tell if the stroke was the type that would be helped — or hurt — by a clot-busting drug.

That’s key, considering time is of the essence: the drug needs to be administered within hours of stroke symptoms appearing if it’s going to be effective.

Since The Pas doctors couldn’t differentiate, they couldn’t decide to administer, meaning any patient who needed it would have to wait until they’d been transferred to Winnipeg, at which point, it would be too late.

Now, they don’t have to wait.

As soon as 911 has been called and the patient is on the way to the ER, the call goes out.

More than 600 kilometres to the south, in Winnipeg, Dr. Esseddeeg Ghrooda’s pager alerts him.

If he’s at Health Sciences Centre, he’ll duck into one of two small clinic rooms. If he’s on-call at home, he’ll fire up his laptop.

Once doctors in The Pas have stabilized the patient, Ghrooda is patched in via a video feed.

As a neurologist, stroke specialist and director of TeleStroke, it’s his job to walk the local doctors through a quick assessment, and analyze the CT scan to decide whether a clot-buster should be given.

“We have to be very fast,” he says, “there’s no time.”

On Friday, in recognition of Digital Health Week, Ghrooda did a sample consultation for the Free Press, calling The Pas to help Dr. Oveis Golchin treat fake patient “Tim.”

On a large monitor, Ghrooda has a full view of the hospital bed. Tim, in turn, has a full view of Ghrooda from his small clinic room.

Tim’s CT scan results will show up later on an adjacent smaller monitor.

A quick evaluation — close your eyes tight, show me your teeth, stick out your tongue, lift up your left leg and hold one, two, three, four, now your right leg — will confirm the stroke symptoms and the scan will tell Ghrooda whether a clot-buster may help reverse some of the damage before it’s too late.

“If you intervene very quickly to break up the clot, then the damage won’t happen,” Ghrooda says. “Blood will come back to the area of the brain and the recovery will happen very quickly.”

Golchin administers the drug, Ghrooda checks back an hour later, and Tim doesn’t wait hours for a transfer to Winnipeg, his brain dying as he goes.

Since its launch in 2015, TeleStroke has seen a steady increase in patient volume: 60 calls in its first fiscal year, 90 during the last one and now, Ghrooda says, it is on track for 120.

While he’s enthusiastic about the money Manitoba eHealth services saves, he’s particularly proud of what TeleStroke means for patient care. Of the 90 consults Ghrooda and his colleagues did last year, 29 patients were given a clot-busting drug.

That’s 29 people who, had they had a stroke a few years earlier, would have likely faced irreversible damage.

“Imagine,” Ghrooda says, “depending on their stroke, they can’t move their arm, they can’t move their leg, they can’t walk again, they can’t see, they can’t talk.”

It’s not just a question of there not being enough neurologists or stroke specialists, says Liz Loewen, director of co-ordination of care for Manitoba eHealth.

Since roughly one patient a month arrives at the ER in The Pas exhibiting signs of a stroke, even if a specialist were on-site, they wouldn’t build up the knowledge or confidence to handle that one case.

“It’s really that confidence that helps them say, ‘I’m really confident that that’s the right choice for this particular stroke,’” Loewen says. “Because they wouldn’t see it every day, they wouldn’t have that nuance if it’s a tricky case.”

jane.gerster@freepress.mb.ca