Improved Availability and Guideline Compliance with a Remote Presence Neurointensivist Program

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Material contained herein is embargoed until 1:00 pm Pacific/4:00 pm Eastern Tuesday, May 3, 2011 ** We face a changing landscape of national health policy, increasing patient needs and physician shortages. One particularly innovative solution provides neurointensivist support and neurologic coverage for hospital emergency departments, especially among those designated as a Comprehensive Stroke Center by the Joint Commission.

Please note, material contained herein is embargoed until 1:00 p.m. Pacific Time/ 4:00 p.m. Eastern Time Tuesday, May 3, 2011

Ojai, CA--PressReleasePoint— In healthcare today, we face a changing landscape of national health policy, increasing patient needs and physician shortages. Providers want efficient and effective solutions and are increasingly turning to telemedicine technologies for answers. Remote physician presence using telemedicine technologies leverages the availability of limited resources and ensures that care is available when and where it is needed.

One particularly innovative application provides neurointensivist support and neurologic coverage for hospital emergency departments, especially among those designated as a Comprehensive Stroke Center by the Joint Commission. There are only 215 Board Certified neurointensivists in the United States, thus the leveraging of this limited resource is necessary.

According to Dr. Herb Rogove, President and CEO of c3o Medical Group http://c3omedicalgroup.com , one remote telemedicine physician program in Southern California has demonstrated more rapid patient access to neurological care, better compliance with guidelines and improvement in national quality standards. This is according to results presented at the American Telemedicine Association’s 2011 Annual Meeting http://www.americantelemed.org/i4a/pages/index.cfm... during a panel on physician compliance and quality metrics.

The team of three remote vascular neurologists, who are also board-certified in neurocritical care, treated 129 patients over nine months. During this period, the response time for the off-site physicians was 21.8 minutes compared to greater than one hour for local neurologists to physically arrive at the facility. The remote physicians attained a significant increase in compliance with Joint Commission metrics related to blood clot prevention, clot dissolving medications, cholesterol lowering medications, and stroke education. However, during the course of the following year compliance by the local neurologist was significantly improved, attributable to the standard set by the telemedicine neurolcritical care physicians, as well as, the fact that outcome data was shared between both groups.

Physicians are open to new approaches and solutions to the challenges they face on a daily basis. For example, emergency department physicians are too often frustrated because they believe more stroke patients should receive the clot-busting drug t-PA. However, local neurologists are not always available for emergency consultations and identification of appropriate candidates. Once this hospital started their telemedicine program, they realized an increase in utilization of t-PA, as well complex diagnoses and treatment for patients with neurological emergencies.

According to Rogove, “in order for the implementation to be successful, you need buy-in at the highest executive level.” In the case of this hospital, there was a growing need for the hospital to become a comprehensive stroke center, which in turn would increase patient revenue. Hospital leadership (physician, nursing and administrative) realized that the diversion of stroke patients by the County EMS system, which also required a hospital stroke designation, would not be consistent with the hospital’s goal and would result in patient loss.

Identifying the opinion leaders and change agents and involving them in planning is important. In this case, the strongest opinion leader turned out to be the hospital CEO, who understood the value of the program to patient care and physician buy-in.

Resistance to change and the fear of losing patients did exist among local neurologists in the beginning, but they soon understood that the telemedicine program served as a partner for providing emergency care to their patients. The remote team of physicians was available to see their patients in emergencies or when they couldn’t break away from their office practice or get to the hospital.

Motivation from the external organizations also proved helpful. In this case the American Stroke Association’s quality metrics and the Joint Commission’s performance measure reporting and feedback mechanisms helped gain physician compliance.