TeleStroke in Capital Health

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TeleStrokein Capital Health
Khurshid Khan, MD, FRCPC Div. of 
Neurology University of AlbertaTeleStroke
Physician Lead
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Impact of Stroke

• Stroke is the 1 cause of acquired adult chronic
  disability.
• Stroke is the leading cause of death after
  cancer and
• cardiovascular diseases.
• Most common neurological condition requiring
  admission
• to hospital
• 20 fatal.
• 75 of survivors live with some level of
  disability.
• Stroke incidence doubles each decade after age
  55.

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Stroke in Alberta

• 5,500 new stroke case per year.
• 25,000 stroke survivors.
• Cost 300M per year.
• 1-2 increase in the occurrence of stroke per
  year for
• the next ten years.

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TIA Facts

• Risk of stroke after TIA or minor stroke is 21.5
  over 5 years.
• 90 day Stroke risk after TIA 10 12 .
• Half of these occur within 2 days of TIA.
• Early assessment and intervention may reduce the
  risk to 2.

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Stroke Prevention Clinic

• Stroke prevention clinic (U of A) receives over
  2300 referrals
• / year for assessment of stroke and TIA.
• High volume may result in delay in access.
• Long distances from specialized stroke centers
  add to
• delayed access.
• 55 of patients seen stroke clinic come from
  remote areas.
• Inconvenience and stress associated with Long
  distance
• travel and cost.

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Objectives of TeleStroke

• To improve timely access to multi-disciplinary,
  specialist driven,
• investigation and management of acute stroke
  and secondary prevention.
• To increase capacity for investigation and
  management of stroke in the
• ambulatory setting.
• To reduce admissions to hospital for stroke
  investigation.
• To improve patient and family satisfaction with
  stroke care.
• To increase support to the community managing
  stroke patients.

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TeleStroke Program

• In 2003, CHA launched TeleStroke to extend
  specialized
• stroke care to patients in remote locations.
• Capital Health provides specialized stroke care
  to Northern
• Central Alberta including the Territories,
  British Columbia
• and Saskatchewan.
• Over the past 4 years the TeleStroke program has
  expanded
• to include an innovative Acute TeleStroke
  program, Stroke
• Rehabilitation program and Dietician
  consultations.

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Components of the TeleStroke service

• 1. TeleStroke prevention clinic
• 2. Acute stroke care

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TeleStroke Prevention Clinic

• Consultation process
• Referrals are sent to the A.H Owen Family
  Stroke Prevention Clinic at the University of
  Alberta Hospital
• Triage process by stroke fellows / stroke faculty
• TeleStroke coordinator / assistant
• Remote site
• Potential for 5 day clinic

.
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TeleStroke Clinic Sites
TeleStroke currently has 52 available sites for
clinic visits.
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Results

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TeleStroke Prevention Clinic

• Average time interval 2 weeks.
• More than 95 satisfaction.
• Telehealth seen as an acceptable means of
  healthcare
• services by both health providers (100) and
  patients
• (92).
• 83 of patients stated that they preferred a
  Telehealth
• session to a face-to-face visit in Edmonton.
• Cost saving of 300 700 reported by the
  patients.

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Acute Stroke

• Blood flow must be restored rapidly to prevent
  permanent
• damage to the brain.
• Time is Brian - window of treatment opportunity
  is 3 hrs
• from symptom onset.
• Only 2 5 avail thrombolytic treatment.
• One of the major factor is late arrival to
  specialized stroke
• center.

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1. Hinton Health Care Center 2. Camrose Health
Care Center 3. Cold Lake Health Care Center
4. Red Deer Hospital
Remote Primary Stroke Care Centers

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Acute Program Results

• Rate of thrombolysis
• Average time of onset to patient arrival in
  Remote
• ER
• Average time from ER arrival to tPA
• Average Baseline NIHHS
• Mean Modified Rankin Scale 90 day post tPA
• 90 day Mortality rate
• Total number of intra - parenchymal Hemorrhage

22.6 vs. 2-5 (Edmonton 19) 90.6 min 78.8
min 16 lt 2 6/29 3/29
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Dietician Consultations

• The Stroke Prevention Clinic offers dietary
  support to patients
• who do not have access to a dietician in their
  community.
• Consultations are arranged by the TeleStroke
  Coordinator.
• Prior to the Telehealth session, a three day food
  diary is sent to
• the patient.
• The dietician then reviews the diary and tailors
  an individualized
• learning plan for each individual.

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Nursing Education Sessions

• During the Telehealth appointment the
  neurologist may
• identify some specific education needs for the
  patient.
• Once identified, the neurologist will then refer
  the patient to
• the Education program with specific outlined
  risk factors.
• The TeleStroke Nurse Coordinator then develops
  an
• individualized interactive learning plan with
  specific learning
• goals and arranges follow up sessions with the
  patient.

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Conclusion

• TeleStroke is an acceptable alternative for many
  stroke
• patients from remote areas outside of
  Edmonton.
• TeleStroke has improved access to specialized
  stroke care
• for patients from remote Northern Central
  Alberta and
• beyond providing the entire continuum of stroke
  care to
• remote patients.

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Acknowledgements
Tammy Whittaker RN, BScN,Regional TeleStroke
Program Coordinator Johnny Ibrahim Regional
TeleStroke Program Assistant Partnering Primary
Care Centers