Telestroke reduces stroke statistics

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By Dennis Faith, M.D. – Emergency Medicine Physician

May is National Stroke Awareness Month, and did you know that strokes are the fifth leading cause of death in the United States? That being said, did you also know that Tri-County Health Care’s new Telestroke program is reducing that statistic?

stroke-Telestroke care-Tri-County Health Care-emergency medecine

Dr. Dennis Faith, Emergency Medicine Physician (right), works with staff from TCHC and St. Cloud Hospital’s Stroke Center to implement and continue Telestroke care at Tri-County Health Care in Wadena.

Strokes occur when a blood vessel is either blocked by a clot or ruptures. This deprives the brain of blood and oxygen, destroying millions of nerve cells within minutes. The resulting damage can lead to paralysis, speech difficulties and emotional problems.

Tri-County has made amazing strides in treating stroke patients with its Telestroke program, which it introduced in the fall of 2016. It works like this:

If you or your loved one comes to the emergency room with stroke symptoms, we have immediate access to a 24/7 stroke intervention specialist at the St. Cloud Hospital Stroke Center through a live video conference. That specialist can conduct a brief interview and interactive examination and see lab tests and images in real time as if they were standing in the room.

In mere minutes, we can complete a comprehensive stroke evaluation, administer clot-busting medications, dispatch a medical helicopter and transfer you for life-saving care. In many cases, you can receive stroke-reversing treatments within 30 minutes and actually be landing in St. Cloud within 60 minutes.

But here’s the important piece: We can’t help you if you don’t get here. And you need to get here within the treatment window. That time frame is up to four and a half hours from symptom onset. Though, even if you wake up with stroke symptoms, we could still treat you. We can do this with multiple interventions, such as administering medication that dissolves clots or utilizing methods that “fish” the clot right out of the blood vessel.

This means you need to learn to recognize stroke warning signs and act quickly. Symptoms aren’t always left-side numbness and slurred speech. It could be a little hand weakness, slight vision change or dizziness. Other symptoms include confusion, severe headaches and difficulty walking.

A helpful way to remember the signs and symptoms of a stroke is “FAST”:

Face Drooping: Ask the person to smile. Is one side of the face numb or does it droop?

Arm Weakness: Ask the person to raise both arms. Is one arm weak or numb?

Speech Difficulty: Ask the person to say a simple sentence. Is speech slurred, are they unable to speak or are they hard to understand?

Time to call 911: As soon as you have even the slightest thought that your symptoms could be a stroke, call 911. Don’t call the hospital. Don’t call the clinic. Call 911. Our paramedics are trained to start the evaluation and treatment process wherever you are: home, work, the lake or a local store.

Tri-County has invested a lot of resources and a lot of faith in this program, and it’s working. This technology clearly improves our ability to provide stroke care here at Tri-County, and in fact, has already proven invaluable with several of our patients. The early data shows us that we’re treating more patients with appropriate treatment, we’re treating them faster and their outcomes seem to be better. So the moment you suspect a stroke, call 911 and get here. Once you arrive, you’re only two minutes away from a stroke specialist and the best care modern medicine has to offer. Any time of the day, every day of the year, we are prepared, we are here, we are trained and we are ready!

For more information about Telestroke and other services offered by the TCHC Emergency Department, click here.

 

Dennis Faith-M.D.-Emergency Medicine

Dennis Faith, M.D. – Emergency Medicine Physician

About the Author: Dennis Faith, M.D., specializes in emergency medicine, with special interest in preventive medicine and clinical research. A science nerd at heart, Faith loves that medicine allows him the opportunity to combine his interests of working with kids, teaching and researching. Though he has a lifelong fascination with astronomy and recently got back into cycling and triathlons, most of his time, by far, is spent with his family.


Community Paramedics…Adapting to the changing face of health care

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By: Allen Smith, Manager of the Emergency Medical Services Department

We all know that trips to the hospital are EXPENSIVE and getting there via an ambulance doesn’t decrease the price tag. Tri-County Health Care believes that the emergency department is necessary, but sometimes sadly it is an option that just fills a void. To help minimize health care costs to the community, reduce readmissions to the hospital, avoid unnecessary trips to the emergency room and help patients receive the best care possible, Tri-County Health Care has implemented a Mobile Integrated Health Care Program.

Allen Smith

Allen Smith

In its simplest definition, Mobile Integrated Healthcare (MIH) is the provision of health care using patient-centered, mobile resources in the out-of-hospital environment. It may include, but is not limited to, services such as providing community paramedicine care, chronic disease management, preventive care or post-discharge follow-up visits; or transport or referral to a broad spectrum of appropriate care, not limited to hospital emergency departments. These alternative pathways to receive care, help bridge gaps in patient care, seek appropriate health care options and offer early preventative measures to prevent hospital readmissions. This program improves patient care, improves population health and reduces the cost of health care (the triple aim). The right care in the right place at the right time.

Traditionally, the role of the paramedic was…

  • To respond as a health care provider to 911 emergencies;
  • To quickly assess the patient’s condition;
  • To provide interventions according to protocol;
  • To transport patients to an acute care hospital.

The Mobile Integrated Health Care program was developed to redefine the role of the paramedic and be an extension of the primary care provider into the patient’s home. Physicians recommend high-risk patients for this program and the Community Paramedic visits are individualized based on patient needs. The program sends paramedics into the community to make home visits and works in collaboration with the medical team, including physicians and the care coordinators. During home visits, paramedics often focus on patient well-being, medication reconciliation and home safety. When needed paramedics conduct post-stroke follow-ups, EKG (heart rhythm tests), blood glucose checks, vital signs taken and blood draws.

This program was never intended to be a substitute for long-term care. It was designed for short-term care and is now considered part of the Health Care Home model. The paramedics also refer patients to other programs in the community. The trained community paramedics provide individualized care and take pride in transitioning patients to other community programs, such as home care, at the appropriate time.

In 2015, the Tri-County’s Mobile Integrated program has…

  • Seen 203 total patients
  • Saved $102,000
  • Received $143,00 in grants

And, since its inception, the program has been recognized at a state and national level. The program has been published in the Minnesota Physician magazine and Tri-County leaders have been asked to be a member of a state advisory group, as well as present program components at both state and national conferences. The program was also a featured organization in the most recent edition of the National Association of EMT magazine.

Most recently, Tri-County has become one of two nationally featured agencies identified by the NAEMT (National Association of Emergency Medical Technicians) in a white paper to Congress. Tri-County was recognized as the rural health care model in defining what a Mobile Integrated Health Care program should look like. The other organization resides in Reno, Nevada and represents large metro agencies.

One example of the Community Paramedic’s impact in the community is a man with violent mental health issues. Prior to the program, this patient had eight visits to Tri-County’s Emergency Department in 2013 and six visits to other facilities. These encounters didn’t just impact the Emergency Department, but also law enforcement. All of these visits resulted in the patient needing to be chemically or physically restrained and eventually ended in being committed to a mental health facility.

Since being visited regularly by a Community Paramedic this same patient is no longer committed and in the last 17 months has only had two Emergency Department visits, neither which required restraint nor security interventions. And, the patient is currently looking for employment.

Savings for the Patient:

Average cost per visit = $5,420

  • ED Facility and professional Charges = $1,500
  • EMS Transport to ED                        = $2,120
  • EMS Transport to Mental Health     = $1,800

Total for 14 ED Visits in 2014                                         = $75,880

Total cost for all Community Paramedic visits              = $918

(16 months’ worth of visits at $57.37 per visit / month)

Emergency Department costs in last 16 months         =$16,260

Health care savings in last 16 months                           = $58,702

No people being harmed                                                 = PRICELESS

The Mobile Integrated Health Care program is a wonderful program that not only meets the federal guidelines outlined in the Affordable Care Act, but it also makes a difference to patients. To see our patients return to a more normal way of life is a true indicator that we are doing the right things for the right reasons.

Allen Smith speaks in Duluth at the League of Minnesota Cities Conference in June 2015…

About the Author…

Allen Smith has more than 35 years of accumulated experience encompassing a variety of Emergency Service roles including fire fighter /paramedic, flight paramedic, EMS Educator, and currently the Manager of the Emergency Medical Services department at Tri-County Health Care. Allen lives in Baxter with his wife Kirsten. He has four children ranging in age from 17-32 years old.