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New York Presbyterian brings ER to patients via Mobile Stroke Treatment Unit

Posted on November 3, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

After a year in operation, New York Presbyterian’s (NYP) Mobile Stroke Treatment Unit (MSTU) continues to be a shining example of how healthcare technology can be used to facilitate true patient-centered care.

“The MSTU program was started with the singular goal of reducing the disability resulting from stroke,” explains Dr Michael Lerario, Medical Director of NYP’s MSTU Program and Assistant Professor of Clinical Neurology at Weill Cornell Medicine. “There is a term we use when we talk about stroke: Time is Brain. Every minute that passes after blood flow is even partially cut off from the brain, 1.9 million brain cells die from the lack of oxygen. This loss can lead to severe cognitive and physical disability for patients.”

Two feet longer than a regular New York City ambulance, the MSTU houses a Samsung portable computer tomography (CT) scanner, a point-of-care laboratory, a complete mobile EHR station (with super-fast WiFi) and a Cisco tele-presence system. The MSTU is staffed by four team members who are specially trained:

  • 1 CT Technician
  • 1 Registered Nurse (RN)
  • 2 Paramedics

With this sophisticated equipment, the MSTU team is able to bring stroke treatment directly to patients where they are instead of waiting for the patient to be transported to the hospital’s ER. Those precious minutes can be the difference between a full recovery and months of rehabilitation (or permanent disability).

When a 911 call comes in, the operator quickly determines if it is a potential stoke situation using a predetermined set of criteria (Plerior referrs to them as “triggers”). This specific protocol was jointly developed by NYP and the New York Fire Department which handles all 911 calls. If the criteria are met, the MSTU is dispatched to the patient’s location.

Upon arrival, the MSTU team stabilizes the patient and quickly conducts a number of diagnostic tests using the equipment onboard: PT/INR test, hemoglobin test and a CT scan. The CT images are sent wirelessly in real-time to NYP’s PACS system where the on-call neurologist reviews the results with the MSTU’s RN via a tele-conference. Based on the scans and the onsite lab work, the neurologist and the onsite team can decide the best course of treatment.

If the scans show that the patient is suffering an ischemic stroke (an obstruction within a blood vessel supplying blood to the brain) and is not already taking anticoagulant medication, then tPA (tissue plasminogen activator – a clot dissolving medication) can immediately be administered. Often referred to as the “gold standard” of Ischemic Stroke Treatment, if tPA is administered quickly it significantly improves the chances for a full recovery.

“Right from the beginning we had complete buy-in and support from within our organization,” says Lerario. “The Neurology and Emergency Medical Services departments in particular were very excited about the MSTU program. They had seen the positive impact MSTU’s were having in Europe and the team wanted to bring that treatment to the people of New York City.”

In just one year of operation, the MSTU has been dispatched on 400+ calls and the response from patients has been universally positive. In fact, a number of cases have been highlighted as good news stories in the press including one about a famous Brazilian singer.

“It won’t be long before mobile stroke treatment will become the standard of care,” Lerario continues. “The benefits are now well documented and more and more people are becoming aware of the impact an MSTU can have on your quality of life following a stroke. People are starting to demand this type of care from their care providers.”

MSTUs are also fantastic for healthcare as a whole. It costs far less to operate an MSTU than it does to treat and rehabilitate patients who suffer disabilities because tPA was not administered quickly enough.

From a patient, provider and public perspective, New York Presbyterian’s MSTU is a winning combination of healthcare technology and patient-centered thinking.

Telemedicine Center Is “Hospital Without Beds”

Posted on September 30, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

You don’t usually read cutting-edge healthcare stories on the CNN Money site, but the following blew me away.  Chesterfield, MO-based Mercy Virtual Care Center is a first, a four-story facility focused entirely on virtual care.

As I’ve noted previously, hospitals seem quite interested in rolling out telehealth services — and virtually all seem to be experimenting with them to some extent — but technology concerns seem to be holding them back. This is happening, in part, because EMR vendors have been slow to integrate telehealth functions.

But this doesn’t seem to have been a problem in this case. The $54 million Mercy Virtual Care Center, which describes itself as a “hospital without beds,” launched in October 2015. It employs 330 staffers focused on a variety of telehealth services, according to CNN Money.

The Center, which calls itself the world’s first facility dedicated to telehealth, offers four programs:

  • Mercy SafeWatch, which the Center says is the largest single hub electronic intensive care unit in the nation
  • Telestroke, which offers neurology services to emergency departments across the country which don’t have a neurologist on site
  • Virtual Hospitalists, a team of doctors seeing patients within the hospital around the clock using virtual care technology, and
  • Home Monitoring, a service which provides continuous monitoring more than 3,800 patients

Center medical director Gavin Helton told CNN Money that the programs it runs are focused on cutting down the cost of care reducing the admissions. “The sickest 5% of patients are typically responsible for about half of the healthcare spend and many end up, unnecessarily, back in the hospital,” he told the site. “We need an answer for those patients.”

One activity run by the Center is a pilot program focused on remote care for patients in their homes. The initial phase includes 250 patients with complex chronic illnesses for whom care is not readily accessible.

For example, one patient enrolled in the program is Leroy Strubberg, who is recovering from three mini strokes and also has heart problems, CNN Money reports. Strubberg, who lives more than an hour away from parent hospital Mercy St. Louis, participates in the Center’s in-home care program, speaking with Virtual Care staff members twice a week.

The staffers, dubbed “navigators,” call him on his hospital-provided iPad and ask him about his status. They also encourage his wife to use a blood pressure cuff and other devices connected to the iPad to check his health.

Since Strubberg enrolled in the program, Mercy Virtual Care clinicians were able to help him avoid hospitalization twice while providing him with appropriate care, the article says.

All of this would be exciting regardless of how it played out, but the fact that seems to be successful at managing care effectively is an added bonus. Mercy told the site that the Virtual Care program has cut emergency department visits and hospitalizations by 33% since the program opened just under a year ago. They attribute their success, in part to seeing that the patients usually see the same navigator, as well as working closely with the patient’s primary care physician.