Does getting physicians to depend on remote, unknown entities take slightly more coaxing? Again, surprisingly no, says Wentworth-Douglass’ Whitney. From the get-go, his hospital’s relationship with Mass General focused on clinical collaboration, not on a large academic medical center pilfering patients from a smaller, out-of-town facility. “They don’t want these patients to have to travel to Boston or somewhere unnecessarily,” Whitney says. “They want for us to be able to treat the patient here.” Those who need more care than the community hospital can provide get transferred to the tertiary facility.
At the individual physician level, particularly for emergency room doctors facing the tPA question, having stroke expertise a phone call or video chat away adds a degree of comfort, Vaishnav says. “Come December 24 at 2 in the morning, you can always call one phone number for the University of Louisville School of Medicine stroke team.” For fluidity in this back and forth, rely on the physician champion, Farrell says. “An executive physician or chief executive might sign a contract because they think it’s the right thing to do, but the people on the ground aren’t bought into the idea,” he says. “A champion can help be the cornerstone of the program locally. That can help build the bond.”
Success Key No. 5: Technology expertise
When computers are involved, that human bond needs to be unbreakable. Machines malfunction, people get rusty, and technology advances. By its nature, telestroke requires a secure Internet connection, fully functioning computers, and people who know how to use them, as well as someone who can easily fix and upgrade them. Whether a hospital internally provides this last component or hires an outside force to do it doesn’t matter. It simply needs to exist.
Despite St. Luke’s decision to invest in minimal technology initially, the hospital hired GE for three weeks to develop behind-the-scenes processes for secure hospital-to-hospital connections. Wentworth-Douglass kept the IT job in-house, including IT decision-makers in the team of 34 who voted to implement telestroke there. “Those folks, with the IT people at Mass General, had to do a lot to get all of this to work,” Whitney says of the technology put in place. “We had to test it and retest it.” His facility, which the AHA recently awarded a silver-plus honor for its stroke program, also conducts mock stroke drills for staff to maintain their technological skills “in the event that we haven’t used it lately,” he adds.