Biotech Values

[DewDiligence]

Re: NYT cover story on stroke treatment

>As far as a neurologist on call, they could transmit the image over the internet to a neurologist at another hospital.<

This sidebar to the article in message #47554 is about exactly such an arrangement.

http://www.nytimes.com/2007/05/28/health/28strokehosp.html

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Cost Put a Stroke Treatment Out of
Reach, Then Technology Made It Possible

Doctors at Martha’s Vineyard Hospital, the only hospital on the small island off Massachusetts, knew only one drug had been shown to work for stroke, tPA. But, until they adopted a new telemedicine system for hospitals like theirs, they had not been giving it to the 25 or so stroke patients they cared for each year.

One problem was the availability of specialists. Ideally, to give tPA, an emergency room doctor should confer with a neurologist to decide whether a patient is having a stroke and whether tPA would help. That, said Dr. Timothy Tsai, director of emergency medicine at the hospital, was all but impossible. The island, with a year-round population of 15,000 and a summer population of about 120,000, has one general neurologist with an office-based practice. She cannot rush to the hospital for stroke patients, and no one covers for her when she leaves the island.

To have a neurologist always available, the hospital would have to hire the equivalent of two and a half neurologists, said Timothy Walsh, the hospital’s chief executive. They would be idle most of the time while costing more than a half-million dollars.

“We wouldn’t be able to handle it financially,” Mr. Walsh said. Ideally, the hospital would also use an M.R.I. machine, the most accurate brain scan for strokes. But keeping the $1.5 million machine near the emergency department “could never be justified by the business” in diagnosing strokes, Mr. Walsh said. The hospital’s only M.R.I. scanner comes in by ferry on Saturday morning and leaves Sunday night.

And the hospital would also need other specialists, like a neuroradiologist, to interpret the scans and a neurosurgeon to deal with possible bleeding problems. Those impediments left Martha’s Vineyard Hospital in the same situation as most hospitals in the United States: stroke diagnosis and immediate care was the sole responsibility of the emergency room doctor, who, Dr. Tsai said, worried about giving tPA.

The concern is bleeding in the brain — it occurs about 6 percent of the time with tPA and can be fatal. The worst fear is to give tPA, cause a fatal bleed and find out the patient had not even had a stroke.

Then the hospital signed up for TeleStroke, a program offered by two Harvard teaching hospitals, Massachusetts General Hospital and the Brigham and Women’s Hospital in Boston. For $10,000 a year, Martha’s Vineyard Hospital links to the Harvard hospitals with videoconferencing and image-sharing technology.

That allows stroke neurologists at the Harvard hospitals to examine patients remotely and assist the emergency room doctor in deciding whether to give tPA. The neurologists must rely on symptoms and CT scans, which are not ideal for diagnosing strokes, but they are experienced enough to often feel confident in their diagnosis.

TeleStroke is what saved Florence Arnston when she had a stroke on Martha’s Vineyard last October, on the first day of her vacation.

Mrs. Arnston, who is 76 and lives in Lansing, Ill., was having an ice cream cone after lunch when her left hand suddenly felt numb and her foot dragged when she walked. She told her husband she did not feel well, and they returned to their tour group.

A nurse in the group called 911. Within 15 minutes, Mrs. Arnston recalled, she was at Martha’s Vineyard Hospital. There, with TeleStroke, a Harvard doctor determined that she was having a stroke, recommended tPA, and remotely supervised its administration. “It was very scary,” Mrs. Arnston said. “But I recovered and I’m doing very, very well.” Now, she said, her only reminder of the stroke is an occasional numbness in her hand.

“It’s just remarkable,” Mrs. Arnston said. “God was good to me, and I’m very thankful for that.”
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