When patients experience a stroke in Wisconsin, they are typically transported to the nearest hospital that has a designed stroke center. Sattin believes that offering telestroke services will allow more hospitals to be designated as stroke centers in the future.
"If you can hold yourself out as a stroke center, you can get more patients coming to you instead of the hospitals around you that aren't stroke centers," he says. "We need to get some of the rural hospitals on board, because if you have a fairly sizeable rural population, you should be either developing the structure to become a stroke center yourself or you should do it by virtue of one of these telemedicine arrangements."
In the future, Sattin predicts that, as the telestroke network grows, the remote consultations may pull physicians away from caring for their own patients on site. "You can only get interrupted so many times before it really starts compromising operations," he says. "At some point, the telestroke call schedule might need to be separate from the regular on call schedule."
In Los Angeles, CA, the ratio of hospitals to stroke specialists just don't add up, says Latisha Ali, MD, director of the University of California Los Angeles Telestroke Network Partner Program. While there are 60 hospitals in the Los Angeles area, there are only about six stroke neurologists.
UCLA officially launched its telestroke program in January and has a current network in the five-to-ten hospitals range. (Ali was unable to comment on exact numbers.) They are currently in negotiations with hospitals and trying to grow their network. For now, UCLA hopes to generate enough money to pay for the technology and keep the program sustainable.
"Our goal is to provide our hospitals with 24/7/365 clinical stroke expertise which has really been lacking in the community here," she says. "One of the advantages of our program is that you get a stroke expert at the bedside whereas if you were at the community hospital you might get someone who has treated stroke patients in the past, but for whom stroke is not an area of expertise."
According to Ali, less than 50% of patients who are admitted with a stroke actually see a non-stroke specialist in neurology. For neurologists in general, she says there are only four available to treat every 100,000 people in the United States and most of them are not trained in stroke or vascular neurology.
She attributes the shortage in the profession to the inability of physicians to quickly heal patients like in other specialties. However, she finds the specialty exciting, saying that it is rewarding to watch a patient improve under her care.
Ali says she wants to share her expertise with all of UCLA's partner hospitals. During consultations, emergency room physicians, medical students, and residents are often present. She uses the opportunity to walk them through a stroke examination and through the process of localizing a patient's symptoms.
Ali can view everything that is being done to the patient at the remote hospital, which does not have to page her every step of the way because she is right there watching events take place with them. The UCLA system uses high definition video conferencing. Ali says the images are "beautiful" and allow her to view such detail as a patient's pupillary response.
"We can actually move the camera around and zoom around the room and talk to everyone as though we were actually there."