TELESTROKE AT THE RVH Deb O’Dwyer

OBJECTIVES At the conclusion of this power point, along with the handout package, the participants will: Understand the reason for augmenting the existing RVH Acute Stroke Protocol with Telestroke Be able to activate the Tandberg unit and control the camera Be familiar with the Telestroke process Be able to troubleshoot the System Be ready for the Mock

The Ontario Telestroke Program Began in Ontario in 2002 provides a 24/7 emergency service that receives 24/7 technical support from OTN for telemedicine equipment; uses CritiCall to contact a telestroke neurologist using a single on-call system; provides equipment and supports neurologists in their homes or offices for 24/7 coverage

The Ontario Telestroke Program supports discussions between referring and consulting physicians regarding the delivery of tPA; makes CT imaging available to the neurologist; and provides access to neurologists for 24-hour follow-up, if required 12 physicians currently support the provincial program (Toronto, Hamilton, Ottawa, Thunder Bay, Huntsville) 20 referring sites

TELESTROKE AT THE RVH PURPOSE OF TELESTROKE AT RVH To address a projected change in Physician capacity, there will be some Physicians joining the RVH Stroke t- PA Call Schedule who currently do not give t-PA. To accommodate this and also maintain our current status as an Enhanced Regional Stroke Centre, we have been approved to add Telestroke to our Acute Stroke Protocol. Telestroke will also be available for consultation purposes

TELESTROKE AT THE RVH BEHIND THE SCENES The RVH Steering Committee was formed June 2011 Telestroke at RVH was endorsed by the LHIN, Hospital Administration and MAC OTN drops X 2 in ED Trauma Rooms & 2 in ICU installed OTN drops X 2 installed for the PC Workstations housing the MERGE/eFilm software (located in room 2396 in ICU) Red Emergency plugs X 2 installed for the PC Workstations housing the MERGE/eFilm software (located in room 2396 in ICU)

TELESTROKE AT THE RVH BEHIND THE SCENES con’t Nodes were installed on the 2 CT’s and MRI by Siemens to allow communication with the PC Workstations housing the MERGE/eFilm software The RVH Acute Stroke Protocol was revised to include Telestroke (and the ED & In-Patient Stroke Protocols were combined) A Telestroke Downtime Contingency Plan was developed Education was provided to ED Nurses & Clerks, ICU Nurses and Stroke Team Physicians

TELESTROKE AT THE RVH Course of Events in a Telestroke Activation Patient presents in ED exhibiting signs & symptoms of acute stroke Patient is Triaged CTAS 2 Patient is assessed by ED Nurse Patient is assessed by ED Doc Bloodwork & Head CT are ordered using ThromboSTAT order set

TELESTROKE AT THE RVH Course of Events in a Telestroke Activation cont’d Acute Stroke Team Physician notified Decision to utilize Telestroke is made by the RVH Acute Stroke Physician following assessment of patient & NIHSS – notifies ED staff ED Clerk activates Telestroke by calling Criticall

TELESTROKE AT THE RVH Course of Events in a Telestroke Activation cont’d ED Clerk brings Tandberg into patient’s room, connects to OTN jack, plugs in & turns on Telestroke Neurologist calls our Telestroke Tandberg

TELESTROKE AT THE RVH Course of Events in a Telestroke Activation cont’d The Telestroke Neurologist speaks directly to the patient, family & RVH Staff The Telestroke Neurologist has access to the CT which the CT Technologist has “pushed” to the efilm server

TELESTROKE AT THE RVH Course of Events in a Telestroke Activation cont’d Following examination of the patient aided by RVH staff and the CT which has been “pushed” to the efilm server the Telestroke Neurologist makes the decision regarding rt-PA At the conclusion of the session, the Billing Information for Telestroke Consultants is completed by the Referring Physician & faxed to the Telestroke Neurologist by the ED Clerk The Telestroke Neurologist is available for follow-up as necessary

TANDBERG

REMOTE

TELESTROKE AT THE RVH For Troubleshooting, see the Telestroke Package on the Tandberg located outside Trauma 3/4 For problems during a session that are not quickly resolvable call OTN SERVICE DESK Press 1 for Service Desk then 1 for Telestroke Emergency Support

Time is Brain! Sooner is Better The increase in the reperfusion window does not mean there is more time to act. Success of rt-PA decreases as time increases. 1.9 million brain cells die for each minute a stroke patient waits for treatment with rt-PA! Statistically there is no difference in rtPA delivery time between Telestroke & non-Telestroke Slide amended with permission from Rosemary Johnson RVH Grand Rounds May 18/11

Maximum Target Times Thrombolytic Therapy for the Acute Stroke Patient 15 minutes Door-to-Doctor Door-to-Acute Stroke Physician notification 20 minutes Door-to-CT scan 25 minutes Door-to-needle 60 minutes Admission to monitored bed 3 hours Slide used with permission from Rosemary Johnson RVH Grand Rounds May 18/11

TELESTROKE AT THE RVH There is an archived Webcasted inservice from OTN available for your viewing Choose Archived Events Choose Private Events Enter User Name royalvictoria Password telestroke Click on TSM #: _OTN_Telestroke Equipment Training - Royal Victoria Hospital Archived Only Ensure volume up It will start automatically

TELESTROKE AT THE RVH Thanks to RVH Steering Cttee RVH Stroke Physicians OTN

Questions? to Deb O’Dwyer

Please or print this screen with printed name and return to Deb O’Dwyer District Stroke Office _____________________________ Has read the information contained in the presentation entitled “TELESTROKE AT THE RVH _____________________ Thank You!!! Slide amended with permission Tammy Gallagher