A “hub and spoke” stroke-treatment network remotely connecting a far-flung group of hospitals to Strong Memorial Hospital foreshadows much of the future of post-COVID medicine, predicts Adam Kelly M.D., leader of UR Medicine’s telestroke program.
A member of UR’s Department of Neurology and director of the department’s Teleneurology and Regional Development program, Kelly oversees the network.
Launched in 2018, the telestroke program developed more quickly and expansively than it otherwise might have as hospitals across the state had to figure out new ways to work in the face of bed and staff shortages as COVID spread, Kelly says. The UR Medicine program might be the most extensive of its type in the state and is one of the larger efforts nationally, he believes.
The telestroke network began with links between Rochester-area, Finger Lakes and Southern Tier hospitals including Rochester’s Highland Hospital; Thompson in Ontario County; Jones Memorial in Wellsville, Allegany County; Noyes Memorial in Dansville, Livingston County; St. James Hospital in Hornell, Steuben County; Soldiers and Sailors Hospital in Penn Yan, Yates County; Geneva General in Geneva, Ontario County; and the Cayuga Medical Center in Tompkins County near Ithaca.
The network then expanded to the Cooperstown-based Basset Healthcare Network. In addition to Bassett Medical Center in Cooperstown, Otsego County, the Bassett system includes A.O. Fox Hospital in Oneonta, Otsego County; the A.O. Fox Tri-Town Campus in Sydney, Delaware County; Cobleskill Regional Hospital, in Cobleskill, Schoharie County; Little Falls Hospital in Little Falls, Herkimer County; and O’Connor Hospital in Delhi, Delaware County.
In the pre-COVID world, the go-to treatment for stroke patients who needed more complex care than staff could provide in small hospitals in remote and sparsely populated regions was to transfer patients to a larger hospital like Strong that was fully staffed with neurologists.
After COVID hit, that was seldom possible.
“We just didn’t have the beds,” Kelly explains.
In the pandemic’s earlier days, bed shortages were mostly due to a tsunami of COVID patients taking up space that ordinarily would have gone to others. Now, COVID has somewhat subsided and providers have more tools to deal with the virus.
But largely because legions of COVID-fatigued nurses have quit to either work as temps for staffing agencies or left the profession altogether, Kelly says, beds are still short. Instead of handing off patients to larger, urban hospitals, providers at small and rural hospital have increasingly worked remotely with neurologists at hospitals hundreds of miles away.
Telemedicine in some ways falls short, Kelly concedes. While neurologists in Rochester can get a full read of patients’ vitals through video links to their medical records, more information can sometimes be gained in an in-person exam.
Other benefits, however, come into play. Patients who otherwise would have been transported to a hospital in strange city miles and hours away from family and friends can stay close to home, making their hospitalization easier on relatives and friends as well as themselves.
More immediate access to neurologists trained to deal with strokes is an incalculable boon to ED staff, “who may not have the expertise” and therefore to patients.
“For me, expertise the greatest benefit,” Kelly says.
In treating strokes, time is of the essence. For many patients, telestroke treatment makes a key difference.
Strokes happen because clots block arteries or blood vessels leak. In both cases, blood flow to the brain is reduced or cut off.
Quick actions like ordering immediate MRI scans to precisely pinpoint and determine the scope of a clot or bleed and promptly administering medications like anticlotting drugs are vitally important for stroke sufferers.
If blood flow isn’t quickly restored, brain cells die. Those who suffer small strokes known as transient ischemic attacks can quickly regain lost functions. But even slight delays in treatment of those who suffer more significant blockages or bleeding can mean permanent loss of functions like speech and muscle control or long, painful recoveries in which functions are only partially restored. The most severe sufferers can be trapped in their own bodies, aware but unable to move or speak, sometimes for years.
For hospitalized, recovering stroke sufferers, Kelly says, the telestroke network has meant a level of care beyond what was previously possible. Small and rural hospitals often do not have neurologists on staff. And in sparsely populated areas, the nearest neurologist is likely to be a long drive or ambulance ride away.
As providers have become more adept with dispensing remote care and patients who in regular life have Zoom meetings or FaceTime chats with family members, Kelly says, UR Medicine’s telestroke neurologists have been able to expand what he calls “longitudinal care,” remotely following up on patients’ progress and even arranging outpatient remote visits with discharged patients.
Had the pandemic not spurred rapid expansion, telemedicine like UR’s telestroke program might have more gradually advanced to where it is now, Kelly says. As it is, he believes, its expansion has had more positives than negatives.
In any event, Kelly adds, the staff and bed shortages that have spurred its accelerated adoption and growth don’t seem likely to clear up soon. Telemedicine is here to stay and will most likely become more commonplace, he predicts.
Will Astor is Rochester Beacon senior writer. The Beacon welcomes comments and letters from readers who adhere to our comment policy including use of their full, real name. Submissions to the Letters page should be sent to [email protected].