Today 172

Yesterday 1042

All 39389281

Tuesday, 19.03.2024
eGovernment Forschung seit 2001 | eGovernment Research since 2001

It was only two weeks ago that Scott Friese suffered a stroke that could have killed him or left him permanently disabled.

The Shelby County resident survived, and expects to experience no lasting side effects, in part because his symptoms emerged about 12:30 p.m. when he sat down at a Mother’s Day brunch in Effingham surrounded by people who noticed he looked ill.

Another factor in his favor was that he had quick access to a doctor through an Effingham hospital emergency department who diagnosed his stroke. And finally, Friese quickly became the patient of a doctor in Springfield who removed the blockage in his brain with a non-surgical procedure May 14 at HSHS St. John’s Hospital.

“I was very fortunate,” said Friese, 54, a divorced father of four who has been able to return to work as a union electrician at Caterpillar Inc.’s Decatur plant. “It helped me avoid permanent damage.”

Friese’s experience can be credited to the growing availability of telemedicine services in downstate Illinois and the audio and video technology bringing more specialty services to patients’ bedsides at rural hospitals in central and southern Illinois, according to Dr. Jacob Kitchener, medical director of the stroke program at St. John’s.

Friese is faring much better than the norm. Eight out of 10 people who have the type of stroke Friese suffered are dead or disabled soon afterward, said Kitchener, an interventional radiologist.

Kitchener used a catheter inserted near the groin and snaked through the torso, neck artery and into the brain to perform what is known as a “mechanical thrombectomy” on Friese.

The odds of a good outcome were increased ever before Friese came to St. John’s. He was able to receive an intravenous dose of a clot-busting drug known as tPA shortly after he was brought by ambulance to HSHS St. Anthony’s Memorial Hospital in Effingham. The procedure in the brain came after Friese was flown the 75 miles between Effingham and St. John’s on an ARCH medical helicopter.

The neurologist who diagnosed the stroke was based in Ohio but was able to see and hear Friese remotely through a “robot” in the St. Anthony’s emergency department.

That doctor is one of six neurologists, all licensed to practice in Illinois and based across the country, who work for a company that Hospital Sisters Health System pays to be on call at all hours of the day or night, even when potential stroke patients need to be evaluated in the ER at 439-bed St. John’s.

The on-call neurologists, as well as the robots that ER personnel in rural hospitals use to take advantage of real-time, high-definition video and audio, make the system efficient and fast, according to Dr. Gurpreet Mander, chief medical officer for St. John’s.

He also is executive director of the Illinois Telehealth Network, an HSHS-led coalition of 26 hospitals and health care providers.

Fourteen of the network members have 24-hour telehealth coverage for stroke patients through their ERs. Those 14 include HSHS hospitals in Decatur, Litchfield, Belleville, Shelbyville, Greenville, Springfield, Highland, Breese and Effingham.

Also included are non-HSHS hospitals: Boyd Memorial in Carrollton, Hillsboro Area, Carlinville Area, Mason District in Havana and Pana Community.

‘Door-to-needle’

The tele-stroke program has treated more than 1,500 stroke patients in ERs at St. John’s and throughout the region since it began in 2014, officials said.

Some of the stroke patients end up at St. John’s, especially if they receive tPA and need expert monitoring, Kitchener said. St. John’s, which cares for about 500 stroke patients each year, performs interventional procedures in the brain to stop strokes for four or five patients each month, he said.

The tele-stroke network actually has helped more patients remain at their home hospitals because evaluations from neurologists through the robot can make local doctors more comfortable treating less-severe symptoms, Mander said.

The telehealth network has secured more than $300,000 in federal grants to help hospitals buy, rent and maintain the robots, which cost $42,000 apiece, according to David Mortimer, director of the HSHS Foundation’s Innovation Institute.

Kitchener said the network has helped reduce member hospitals’ “door to needle” time — or the time between when a patient enters the ER to when he or she receives a clot-busting drug.

That reduction, combined with the option of interventional procedures in the brain — procedures that can cost $20,000 — undoubtedly have saved lives and reduce disability from stroke, he said.

Patients diagnosed with stroke at rural hospitals in the network likely will come to St. John’s if they need specialized care but can choose to go elsewhere, Mander said.

HSHS hopes to grow the number of health care providers and services provided through the telehealth network, he said. But one challenge in Illinois is that insurance plans tend to reimburse telehealth services at lower rates, or not at all, compared with in-person care, he said.

Legislation could help to address this problem, he said.

Increasing parity for telehealth services “is the only way we will be able to expand these services,” Mander said.

Lack of urgency

At 500-bed Memorial Medical Center — one of St. John’s Hospital’s main competitors — neurologists and other specialists from Southern Illinois University School of Medicine help evaluate potential stroke patients in-person in Memorial’s ER and via telemedicine equipment at more than 20 downstate locations.

Memorial offers in-the-brain procedures, as well, from four doctors: neurointerventional radiologist Dr. Augusto Elias, two other Clinical Radiologists doctors — Casey Muehle and Robert Burke — and SIU neurologist Dr. Fazeel Siddiqui.

At St. John’s, Kitchener, a member of HSHS Medical Group, and HSHS neurologist Dr. Naim Khouri handle the procedures.

Memorial isn’t a member of the Illinois Telehealth Network but is seeing a growing number of patients and services provided through its telehealth partnership with SIU, said Evan Davis, Memorial’s administrator for orthopedic and neuromedicine.

The SIU physicians who are on the other end of the telemedicine equipment, and those in Memorial’s ER, provide almost-immediate responses to potential strokes, Davis said.

For Friese, a resident of the Shelby County village of Stewardson, the care at the Effingham hospital and St. John’s was swift and kind, he said. Kitchener’s treatment of Friese included angioplasty to deal with a narrowing in Friese’s right carotid artery, as well as the clot removal in the brain.

Friese was cloudy in his recollection of his condition at the Mother’s Day brunch with his 56-year-old sister and 75-year-old mother. He said he remembers feeling weak in his left leg and left arm but didn’t think it was a serious matter at the time.

That feeling of a lack of urgency can be a common reaction because of the way the brain is affected by a stroke, Kitchener said.

As a result, others going through a stroke while they are alone may not get themselves to a hospital quickly and may receive medical attention too late to avoid permanent damage, Kitchener said.

Friese remembers feeling an excruciating headache for a few seconds, in an area above and in front of his right ear, when Kitchener was removing the clot in his brain.

But Friese said he is grateful for the medical expertise that allowed him to be discharged from the hospital two days after the procedure. He was back to work on May 22.

“It is amazing,” he said, adding that doctors tell him the strength on his left side should be back to normal soon.

He said he had no obvious risk factors for stroke, except for slightly elevated blood pressure and a family history — his maternal grandmother had a debilitating stroke.

Friese said he is trying to reduce his risk of a second stroke by cutting down his intake of sodium and carbohydrates. He’s also on blood pressure and cholesterol medicine, as well as temporary blood thinners and aspirin.

An avid bicycle rider, Friese said he owns 40 bikes. He said he looks forward to riding them, while eating better and keeping a closer watch on his health, for years to come.

“You’re invincible until someone tells you you’re not,” he said.

---

Autor(en)/Author(s): Dean Olsen

Quelle/Source: The State Journal-Register, 27.05.2017

Bitte besuchen Sie/Please visit:

Go to top