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Improving Rural Stroke Care
The Virginia Acute Stroke Tele-Health Network (VAST) initiative is testing the effectiveness of using a robot at Bath Community Hospital to allow stroke experts at UVA to assess and talk to patients and their physicians at the community hospital, some 100 miles from UVA. The robot, known as the Remote Presence Robotic System (RP-7), is being evaluated by VAST in helping neurology experts assess stroke patients without being on-site with them. The RP-7 is a 5-foot-6-inch-tall robot with a flat-panel head and camera-lens eyes. As the RP-7 moves and works, the face of the person at the controls is projected on its flat-panel display. “The robot’s camera and speakers function as my eyes and ears,” says Nina Solenski, M.D., a neurologist in UVA’s Primary Stroke Center and Project Officer for VAST. “It’s on rollers, so I can sit at my laptop and drive it to a patient’s bedside. Within minutes after stroke patients arrive in the ER, I can start helping on-site doctors evaluate and treat them. The RP-7 also lets me speak with patients and zoom in to check their condition myself.” Remotely bringing a stroke specialist to a patient’s bedside could make a huge difference in treating stroke patients in rural areas, where neurologists are in extremely short supply. “We’re at least two hours from Hot Springs by ground, so by the time that patient would possibly get to UVA, it may be too late to administer clot-busting tPA or other medical treatments to help lessen the damage caused by a stroke. With our robot link, we’re right there, interacting with the patient and performing our own assessment and determining the best course of action,” Solenski says. Funded by a $1.3 million grant from the National Office of Rural Health, VAST is a quality-improvement initiative from the Virginia Department of Health, the Virginia Stroke System Task Force and the Virginia Telehealth Network. The program is testing a variety of health information technologies to see if they give rural hospitals quicker and improved access to stroke experts at regional hospitals and other healthcare providers that support them. VAST’s goal is to improve Virginia’s stroke mortality rates – which are among the nation’s highest – and boost the number of stroke patients who receive the lifesaving clot-busting drug t-PA. In 2006, only 2 percent of eligible patients in Virginia received the drug. “Virginians living in rural areas need better access to the kind of acute stroke care and expertise we provide at UVA 24 hours a day, seven days a week,” says Karen C. Johnston, M.D., M.Sc., Chair of UVA’s Department of Neurology. “Our stroke team is excited about the VAST initiative and the opportunity to collaborate with colleagues at Bath Community and at other hospitals around the state. By working together and sharing our expertise through new technologies, stroke care providers can ensure that all Virginians receive the best treatment possible.” Evaluation of the RP-7 will conclude in February. At UVA, the robot’s effectiveness will be compared with bedside results achieved by on-site stroke experts. If the robots prove successful at UVA and Bath Community Hospital, a variety of patients at other rural hospitals throughout the state may have an opportunity to benefit from the technology. “We hope this can be a template to apply to other hospitals and to other specialties,” says Solenski.
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This simple concept is driving the pilot project linking neurologists at the University of Virginia Health System with Bath Community Hospital in Hot Springs, Va.