Over the past five years, advances in research have had an impact on the treatment of acute ischemic stroke such that patients who meet certain criteria may be effectively treated with the "clot busting" drug, tissue plasminogen activase or tPA.
As the use of this drug for this application is relatively new, it is important that candidates for this treatment be assessed by a neurologist who can examine the patient's CT scan and conduct a neurological exam. The drug must also be administered within three hours of onset of stroke symptoms. As there are few neurologists practising outside of urban centres, this treatment would not generally be available to most northern communities.
Neurologist Dr. Frank Silver, Director of University Health Network's Stroke Programme, explained: "Armed with information from the referring physician, the CT image and neurological assessment, neurologists are well informed and able to provide timely treatment advice, even from hundreds of kilometres away."
North Bay General Hospital (NBGH) was the first northern hospital in Canada to participate in this collaborative initiative. Eleven patients seen at the NBGH emergency room have benefited from this service. "The Telestroke initiative offers North Bay physicians and patients as equal access to the expertise of a stroke neurologist as those living in large academic centres", stated Dr. Ralph Dell'Aquila, Emergency Room Physician at the NBGH. "It is a unique way of sharing specialised care in areas that don't have a full complement of sub-specialists."
Sudbury Regional Hospital started its programme in March 2003, and Dr. Peter Zalan, Telehealth Medical Director at the Hospital noted: "This initiative offers Sudbury patients access to the expertise of a neurologist in real time when every moment is precious."
Through the use of the NORTH Network's virtual private network, diagnostic imaging software and two-way video-conferencing equipment, timely treatment advice from neurologists is now available to the residents of Northeastern Ontario. Dr. Ed Brown, Director of NORTH Network stated: "The NORTH Network is very pleased to support this important initiative. By bringing the remote stroke neurologist to the bedside, telestroke will enhance the care of patients suffering from acute stroke and will assist local physicians with difficult decisions."
The programme is supported by a 24/7 help desk, a Web-based physician on-call roster and regular "virtual" Telestroke rounds to facilitate learning amongst the participating health care professionals. Additionally, a strong evaluative framework has been implemented to assess clinical outcomes, as well as patient and provider satisfaction with the model of care.
To date, a total of 12 consults have been completed with two going on to receive tPA. Consult volumes are expected to rise with a targeted public campaign designed to raise the awareness of signs and symptoms of stroke as well as the urgency of seeking medical attention at the appropriate health care facility.
Minister of Health and Long Term Care, Tony Clement, stated: "The Eves government is committed to improving patient care and outcomes for people who suffer a stroke. To date, we have invested $70 million over four years, and in addition we are investing $30 million towards ongoing work in the Ontario Stroke Strategy to ensure that Ontarians have access to appropriate, quality stroke care in a timely manner. The funding for this Telestroke initiative will provide people in North Bay and Sudbury with rapid access to stroke diagnosis and treatment."
"The Heart and Stroke Foundation is very proud to have been a partner with the Ministry of Health and Long Term Care in the implementation of the Ontario Stroke Strategy. The goal is to ensure Ontarians have access to the best stroke care possible", stated Andrew Scipio del Campo, President, Heart and Stroke Foundation of Ontario. "This technology provides a critical resource to ensuring the citizens of North Bay and Sudbury can take advantage of time-sensitive stroke treatments."
"Through initiatives such as Telestroke, the Canadian Stroke Network is working to reduce the impact of stroke and improve quality of care for all Canadians", stated Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network, a national network of university-based centres of research excellence. The Canadian Stroke Network provided $630.000 in funding to cover Telestroke start-up costs. Dr. Hakim stated: "The Network wants to lead the way in stroke research, and it wants to help more people walk away from stroke."
Challenges aside, through the effective use of technology, Telestroke is providing residents of North Bay and Sudbury with access to care previously available only to those living in urban centres and is poised to make a difference in the lives of those who live in these two communities.