Telemedicine Extends Reach of Stroke and Neurological Care
UR Medicine neurologists are now providing remote acute and inpatient neurological care for 16 hospitals across upstate New York, creating one of the more comprehensive hub-and-spoke networks in the nation.
“We are able to provide acute neurologic consultations for any patient who presents to any UR Medicine hospital, as well as some of our important partner institutions,” said Adam Kelly, MD, director of Teleneurology and Regional Development for the Department of Neurology. “While some neurology programs provide remote consultations for patients in emergency departments, our team continues to follow patients longitudinally while they remain in the hospital. This is a major accomplishment that would not be possible without the hard work and dedication of a team of staff and providers, both at Strong Memorial and our affiliate hospitals, who are committed to the concept of delivering virtual care in our region.”
24/7 Telestroke Care
UR Medicine telestroke program has existed for several years but grew substantially in 2018-2019 from a partnership to provide telestroke care to the Bassett Healthcare Network. Curtis Benesch, MD, the medical director of the UR Medicine Comprehensive Stroke Center, led this initial effort prior to handing off directorship to Kelly in 2019. The program consists of a dedicated team of stroke specialists who are available 24/7 to interact with patients and families and consult with medical providers via phone or video.
The system allows UR Medicine neurologists to review brain imaging and other medical data to make recommendations about care, such as intravenous thrombolysis and endovascular therapy, and whether the patient should be transferred to Strong Memorial Hospital for more advanced care or can remain at the original hospital. Unlike many telestroke programs, the UR Medicine service continues in a consultative role at many of its partner sites, ensuring that patients continue to receive high quality care. The telestroke services provided by UR Medicine have helped several partner hospitals receive Primary Stroke Center certification from the Joint Commission.
Hospital-based Neurological Care
At the same time the telestroke partnership launched in 2019, Bassett and UR Medicine expanded the program to provide remote inpatient care for non-stroke neurologic conditions such as seizures, coma, and delirium. The team has given these inpatient services the title “teleneurology.” While there was less evidence to support this model of care, both UR Medicine and Bassett felt that the technical and clinical experiences from telestroke could be extrapolated to other neurological disorders. Teleneurology providers are also available 24/7 to partner hospitals.
The COVID pandemic increased demand and accelerated the need to expand telestroke and teleneurology services to more hospitals. Earlier this month, Jones Memorial, St. James, and Noyes Memorial were the most recent hospitals to join the program, which now covers all six UR Medicine hospitals, the six hospitals in the Bassett Healthcare Network, Cayuga Medical Center, and Geneva General, Schuyler, and Soldiers and Sailors Memorial hospitals. The program also provides telestroke consultation to the on-board staff of the UR Medicine Mobile Stroke Unit.
Keeping Patients Closer to Home
In most cases, hospitals possess the technologies necessary to provide care to stroke and other neurological patients. Access to neurologists who are able to develop a care plan and closely monitor patients means that providers are more comfortable treating patients who would not normally be kept at their hospital. Along with Kelly, telestroke/teleneurology nurse coordinator, Michelle Murphy, RN, has been instrumental in these efforts. The result of the team’s work is that more patients are able to receive their care closer to home.
“We've been able to minimize inter-facility transfers for stroke to the point where we are now only transferring about 15 percent of cases to Rochester. In the past that number was closer to 50 percent,” said Kelly. “It’s come down to the point where we only transfer people if there's a very high likelihood that they need something that we can only provide Strong Memorial, like a neurosurgical procedure or access to the Neuromedicine ICU.”
Kelly notes that acceptance of the by hospital staff and patients and families has been very high. “It’s very humbling to hear the positive feedback about the care we provide, and to work with such a dedicated group of teammates. I’m excited to see what else we can accomplish in this area moving forward.”
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