Advances in the treatment of acute stroke can minimize longterm sequelae and potentially reverse the damage. When administered within the first 4.5 hours of symptom onset, intravenous tissue plasminogen activator, or Alteplase (tPA), can dissolve the offending clot, restore blood flow and preserve function. Unfortunately, for many patients both in rural and urban settings, the lack of access to a stroke specialist can delay time-sensitive treatment and diminish the likelihood of a favorable outcome.
An internationally recognized telemedicine service founded at Augusta University Medical Center known as REACH (Remote Evaluation for Acute IsCHemic Stroke) facilitates neurological consults for patients in hospitals that lack emergency neurology coverage. This pioneering telemedicine service lets neurologists at Augusta University Medical Center diagnose and treat stroke patients at participating hospitals from anywhere, at any time, through a standard computer webcam and broadband internet connection. Since its inception in 2003, our network has grown from 2 rural sites to 29 hospitals including rural hospitals in the CSRA and larger partner hospitals throughout the state. Our goal has always been “the right care, at the right place, at the right time”.
A REACH consult is activated when a physician within the network suspects that a patient is suffering an acute ischemic stroke and may be a candidate for intravenous Alteplase (tPA). Patient demographics are entered into the REACH application via a state of the art cart equipped with dual monitors and a pan/tilt/zoom camera. A call is then placed to the Emergency Communications Center where an operator pages the on-call REACH consultant. Using any computer with high-speed internet capabilities, the stroke consultant accesses the REACH application—providing an immediate connection between Augusta University’s Comprehensive Stroke Center and the remote hospital.
From their computer, the consultants can communicate with the staff, patient, and family using integrated 2-way audio/video and point-tilt-zoom camera controls. Written communication between the hospital and the consultant is continuously updated to ensure the accuracy of data exchange. CT images are transmitted from the hospital scanner to the REACH application and are readily available for the consultant to view.
After thoroughly reviewing all data entered from the hospital (patient history, vital signs, capillary blood glucose, lab values, etc.), talking with the patient and family, reviewing the CT scans, and directly evaluating the patient by completing the NIHSS (an assessment of neurologic deficit), the stroke consultant will make a recommendation of whether to proceed with the administration of the Alteplase (tPA), and further care including transfer decisions.
By making world-class neurological expertise quickly available 24/7, the HIPAA-compliant REACH service
Participating and partner hospitals include:
