Mobile Neurological Assessments to Become Part of Clinical Practice
At a Glance
- A successful research endeavor, iTreat soon will be incorporated into clinical practice.
- By establishing a live video link between the ambulance and specialists in the UVA emergency room, physicians, with assistance from the EMTs, can administer the NIH Stroke Scale exam during ambulance transport.
- iTreat will be introduced not only in rural areas near Charlottesville, but also in urban areas like Richmond and as far away as Hawaii.
As a UVA neurology fellow, Sherita Chapman-Smith, MD, assisted neurologist Andrew Southerland, MD, with the development and study of the iTREAT toolkit, a system that facilitates mobile neurological assessments during ambulance transport. “I’m from a rural area of Virginia and I was an EMT before med school, so I understand the issues that impact the quality of stroke care in a rural setting, including extended transportation times and lack of advanced stroke hospitals – this really hit home for me,” she says.
iTREAT: How It Works
The iTREAT (Improving Treatment with Rapid Evaluation of Acute Stroke via Mobile Telemedicine) toolkit consists of a tablet computer (Apple iPad), a high-speed modem and a portable magnetic mount antenna, and it requires a high-speed internet connection. By establishing a live video link between the ambulance and specialists in the UVA emergency room, physicians, with assistance from the EMTs, can administer the NIH Stroke Scale exam over the video link during ambulance transport. This allows stroke specialists to begin the doctor-patient interaction well before hospital arrival.
“The goal is to evaluate patients out in the field to reduce treatment times and, as a result, hopefully improve outcomes,” says Chapman-Smith. “We are fortunate to have the technology to make this possible, as well as dedicated ER teams and EMS agencies willing to work with us to incorporate this new system into their day-to-day practice.”
Overcoming Barriers to Timely Stroke Care
After extensive feasibility and simulation testing, iTREAT has proven to overcome some of these barriers to quality, timely stroke care. And Chapman-Smith, now a UVA faculty member, is currently working to transition iTREAT from a research to clinical program.
“During the rollout, we completed simulations with 64 patient encounters and 70% were successful. Those that were unsuccessful typically were due to human factors, such as not charging the tablet,” she says.
Chapman-Smith’s mission is to fine-tune the implementation strategy to address those variables. Through focus groups, surveys and review of past patient encounters, Chapman-Smith says she and her team will be equipped to make improvements that will make the program more viable and easily adopted in a variety of settings.
“We have shown that iTREAT is feasible and reliable, however in order to improve implementation and sustainability we have to factor in the complexities of the healthcare organizations and various work practices, as well as the physical environment,” she says. “Our goal is to have the clinical program out within the next year.”
Eventually, Chapman-Smith says the program will be introduced not only in rural areas near Charlottesville, but also in urban areas like Richmond and as far away as Hawaii. “If we are able to take what we develop here and successfully employ it there, then we’ll know it’s something that is sustainable,” says Chapman-Smith. “And we’ll know it’s possible to expand the reach of a comprehensive stroke center like UVA.”
“ITreat was a very successful research endeavor and, through that research, we recognized the value of this program in bringing expertise closer to the patient’s home,” says Nicole Chiota-McCollum, MD, medical director of the UVA Comprehensive Stroke Center. “The earlier we can begin to influence a patient’s emergent care, we believe that will improve the likelihood of good outcomes. We’re excited to translate this research program into part of routine clinical practice.”