For St. Luke’s Hospital, a telestroke program meant a bed-filling opportunity in oversaturated Houston, where three comprehensive stroke care facilities sit on one city block. “We realized there was a huge untapped market,” Livesay says. “Drive 20 minutes down the road and they were doing nothing for stroke patients.” Making the program successful meant careful planning, particularly because the facility took the atypical approach of forging a network first, looking at technology second. “You talk to people about telestroke and they immediately want to focus on technology,” Livesay says. “It’s not that technology isn’t important. But I think that infrastructure and the relationships you build between hospitals is far more important.”
This attitude led to greater focus on care processes and education between St. Luke’s and spoke hospitals, which range from 15 to 250 miles away. Livesay says the telestroke providers set expectations up front and the partner hospitals talk weekly, if not daily.
Though the telestroke team at 178-licensed-bed Wentworth-Douglass Hospital in Dover, NH, doesn’t communicate as frequently with its hub, MGH, when the hospitals decided to partner, they set in place a specific plan. This was crucial for Wentworth-Douglass, which has several board-certified neurologists on staff. Today, the hub doctors act as backup and offer second opinions, says Craig Whitney, vice president of planning and development at Wentworth-Douglass. “We can use telestroke to immediately connect and evaluate the patient in real time.”
Nearly every telestroke program builds from the same real-time consultation-evaluation model. What differs is how the partnership fits into a hospital’s larger scheme, and that comes down to how much faith video-treated patients have in the system and how much the physicians trust their remote colleagues and the care method.
The response of stroke patients treated via telemedicine at MGH surprised Schwamm. Eighty-five percent rated the visit as positive as a face-to-face encounter. “You might think that patients would be put off by this, that they would come into the emergency room and think, ‘Why am I getting a doctor on a television screen?’” he says. “That wasn’t our experience at all.”
St. Luke’s saw similar—unexpected, yet welcome—patient satisfaction. In fact, Livesay says that overwhelmingly, patients viewed telestroke as the hospital providing a service it previously couldn’t rather than skimping on care. “Are patients disgusted that they’re getting their care from a computer? It’s totally the opposite. They feel like the hospital is doing them a favor,” she says.