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Wednesday, October 27, 2010

Tele Neurologist. Specialist On Call.

In a time not so far away, you just brought a friend to the emergency room with symptoms of stroke. Patient has developed right sided weakness and also complaints of slurred speech. ER physician enters the room and evaluate your friend. He recommends that your friend can benefit from thrombolytic therapy. Then he goes on to say that he would need a neurologist to make that call, however, there is no local neurologist on call. You start to get upset and…………….drum rolls…..

………and enters neurologist on wheels, this robot like device is being dragged in to the room by a nurse. On the monitor you see a doctor’s face. “Robot” asks you different questions, examines your friend with certain devices and eventually review your CAT scan of the brain while sitting miles apart. Finally he recommends that he concurs with thrombolytics. He orders it and the nurse administers the lytics. Soon your friend who was unable to speak a minute ago now is talking with you and moving his extremities. Finally you take a deep breath. You know what’s so peculiar about this scenario? THE TIME IS PRESENT, IT’S HERE.

I was invited today to meet with Specialist On Call (S.O.C). They provide expert consultation and evaluation for stroke patients. Their model is telemedicine, where a board certified physician is sitting at a remote facility and evaluates your patient. He makes recommendations appropriately, utilizing most advanced tools available through a computer portal.

This company provides specialty care to those hospitals which lack certain specialties. Like in our program we do not have a neurologist on call for stroke.  So patient who live close to our hospitals are taken to a remote facilities to be treated with thrombolytics.

 Initially I was apprehended by the presentation but after listing to the speaker he was able to answer most of our concerns. SOC was founded in 2005, they are currently working in 105 hospitals around the country and they are (Joint Commission) JACHO accredited. They guarantee a patient–teleneurologist encounter within 15 minutes and are available 24/7. They had 6734 consults in 2009 and recommended 380 thrombolytics. National average for cerebral bleed after thrombolytics is 6 %, they are at 4.5 %.  They recommend collaboration with local neurologist for post thrombolytic care.

Though it seems like a good alternative but it would require a comprehensive protocol before this could be implemented. There is a company in Georgia who is also using the similar device to fill in for nocturnist/hospitalist and so far they have seen good results.

I would appreciate feedback if anyone has been involved with similar projects. 

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