Mayo Clinic uses telemedicine in ambulances to assess stroke patients

A Mayo Clinic telemedicine initiative in Jacksonville, Fla., is helping to speed stroke care during patient transport to the hospital by leveraging mobile videoconferencing technology.

The system from telehealth services vendor InTouch Health of Santa Barbara, Calif., enables neurologists to have a presence in the ambulance to conduct real-time visual assessments of patients while they are being brought to the hospital.

Virtual neurological exams using the National Institutes of Health Stroke Scale enable providers to gauge the severity of stroke and identify the best treatment options, leading to quicker care of patients when they arrive at the hospital.

“Typically, when a suspected stroke patient is in an ambulance being brought toward the hospital, there is downtime—their vital signs are being monitored, but there’s not a lot of active medical care,” says William David Freeman, MD, a neurologist at Mayo Clinic’s Jacksonville campus.

“Mayo Clinic recognized that there was an opportunity for improvement that could directly impact patient outcomes,” Freeman adds. “We believed we could beam in robotically through telemedicine, examine the patient using the national standard of care metric—the NIH Stroke Scale—and use that time to help expedite treatment.”

Currently, Century Ambulance Service in Jacksonville operates two critical care ambulances equipped to provide the mobile assessments through the tablet-like device, secure HIPAA-compliant video software app and cellular connection.

The technology enables a video consultation between neurologists and stroke patients, as well as with paramedics in the ambulances, so they can make more informed medical transport decisions.

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Time is of the essence, according to Freeman, who notes that “for every minute someone is suffering a stroke, 1.9 million neurons die—the faster we can restore blood flow, the better the outcome for the individual.”

He pointed to a 2015 pilot study which demonstrated that virtual assessments in ambulances using iPads reduced by an average of 7.5 minutes the time it took from when patients were confirmed as having a stroke to actually obtaining treatment.

“We’re saving at least 15 million neurons, on average, by doing that examination in transit before the patient physically comes to the hospital,” Freeman contends. “It’s exciting news for patients to know we’re working to get them better faster.”

Freeman says the plan is to augment the two critical care ambulances in the telemedicine-equipped fleet with three “standard” transport units—for a total of five vehicles that will be able to conduct the mobile stroke assessments.

He added that the Mayo Clinic’s other campuses in Minnesota and Arizona are both interested in implementing the ambulance-based solution from InTouch Health. What makes the implementation easier is the fact that two years ago, the Mayo Clinic decided to consolidate its emergency telemedicine services from 11 vendors to just InTouch.

“Our vision for connected care is to use technology to extend Mayo’s reach and deliver the highest-quality care to people at the time and place they need it most,” says Sarvam TerKonda, MD, medical director for Mayo’s Connected Care in Florida. “Telestroke is recognized as a scientifically valid and accepted clinical practice endorsed by the American Heart Association. This new mobile, pre-hospital stroke assessment is an exciting example of innovation that is positively impacting local patients and improving their lives.”

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