April 2 , 2008


Hospital turns to Web to aid stroke patients

Syracuse stroke specialists to diagnose Cortland patients via Web cam


Bob Ellis/staff photographer      
Dr. David Wirtz, emergency room physician at Cortland Regional Medical Center, performs a stroke scale on mock patient Charlie Eaton, the  clinical educator at CRMC, Tuesday during a demonstration of software that connects Syracuse stoke doctors with Cortland patients.

Staff Reporter

A new program at Cortland Regional Medical Center will allow Syracuse stroke specialists to diagnose Cortland stroke patients via Web cam.
The system, known as REACH, for Rural Evaluation of Acute Ischemic Stroke, is designed to link stroke patients at Cortland Regional Medical Center with neurologists based at University Hospital, a state Department of Health-certified stroke treatment center.
A stroke occurs when blood flow to the brain is interrupted, cutting off oxygen to the fragile tissue.
Ischemic strokes occur when a blood clot forms and blocks an artery in the brain. These account for about 80 percent of strokes, according to figures provided by Cortland Regional Medical Center. Hemorrhagic strokes occur when a blood vessel in the brain ruptures and bleeds into the brain tissue.
“It (the brain) dies, and it dies very quickly,” said Jerry Morrison, Cortland Regional Medical Center’s emergency department director.
With the new system, launched March 17, medical staff in Cortland can now consult with one of three dedicated stroke specialists in Syracuse, who can watch the patient’s exam over an Internet feed.
Based on the initial examination of a patient suffering from stroke symptoms, physicians determine whether or not to administer tissue plasmogen activator, or tPA, a “clot-busting” drug that can clear blockages in brain blood vessels typical of ischemic strokes.
Not all patients can be treated with tPA, however, including those whose stroke symptoms have lasted for more than three hours, Morrison said. Perhaps six to 10 percent of stroke patients are good candidates for tPA therapy.
The advantage of the Web-based consultation system is that stroke sufferers can be immediately linked to neurologists without the 45-minute trip to Syracuse, said Dr. David Wirtz, an emergency room doctor at Cortland Regional Medical Center who also is the chairman of the hospital’s stroke committee.
That could allow CRMC to treat and admit stroke patients who would have been transferred to a Health Department-certified stroke treatment center, such as University Hospital, in the past, Wirtz said.
“It’s been an unmet need here for a while,” he said.
Many patients would still require transfer to a certified stroke center, but the Web-based system allows for some initial care to be performed locally, Wirtz said.
Since going online March 17, 11 stroke patients have been treated using the online consultation system, said Morrison. Of those 11, one was identified as a candidate for tPA, but Morrison said the victim’s family declined to use the drug after reviewing the possible side effects.
Hospital staff initially estimated that perhaps 100 stroke patients would be treated during the first year of the program.
In 2006, the New York State Hospital Report Card noted that Cortland Regional Medical Center had elevated mortality rates for five of six common ailments, including acute stroke.
According to the report card, the hospital’s risk-adjusted mortality rate for acute stroke sufferers was 42.6 percent, almost four times the state average of 11.7 percent. The hospital’s stroke mortality rate dropped to 20.2 percent in the 2007 report card.
Wirtz said the new system can put patients into contact with neurologists, who are available around the clock, within five to 10 minutes of being identified as stroke victims.
Using an Internet-connected computer, the neurologists will be able to manipulate the Web camera, zooming in and out and rotating it on two axes, Wirtz said.
While it’s not a true “face-to-face” interview, Wirtz said the drawbacks of the online system are minimal.
“It’s (the stroke examination) fairly objective,” he said. “The neurologists should be able to do it fairly easily on camera.”
The state Department of Health designated Syracuse’s University Hospital as a “Designated Stroke Center” in 2006, and named it as a potential “hub” for the REACH system that fall. After about a year, in October 2007, the hospital was online as the region’s stroke hub.
It’s taken about a year and $75,000, for Cortland Regional Medical Center to purchase the equipment and train the personnel required under the Health Department’s guidelines for the hospital to qualify to connect to the hub at University hospital, said Rochele Clark, University Hospital’s stroke center coordinator.
Cortland Regional Medical Center paid the startup cost up front, but board members are trying to obtain a grant for upkeep and maintenance of the program, said Susan Eoannou, CRMC’s director of business development.
Eoannou said the additional admissions to the hospital that will come thanks to the REACH program should offset the start-up cost of the program.
Clark said Cortland Regional Medical Center and Schuyler Hospital in Montour Falls are the only two currently connected to University Hospital’s stroke-treatment hub, but that plans are in the works to certify additional hospitals in the region.
The Health Department has identified 16 hospitals in the region that could serve as “spokes” in the REACH system, Clark said.
Wirtz said stroke victims will benefit from the possibility of remaining in the area, closer to their families.
“It’s a lot nicer for the patients,” he said.