TeleNeurology | Connected Care | Health Care Professionals | Dartmouth-Hitchcock
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TeleNeurology

TeleNeurology

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Minutes matter during a stroke. D-H TeleNeurology can be there to improve outcomes for these patients and for many others with urgent neurologic issues.

TeleNeurology, a service of Dartmouth-Hitchcock (D-H) Connected Care, enables faster access to patients having neurological emergencies. The TeleNeurology Program provides 24/7/365 consultations by a board-certified neurologist for patients 18 years and older.

Patients are evaluated, managed, and treated in real-time collaboration with the local attending physicians or associate providers. The American Stroke Association (ASA) has recommended that a stroke specialist, using high-quality video conferencing, provide a medical opinion in favor of or against the use of intravenous tPA in patients with suspected acute ischemic stroke when on-site stroke expertise is not immediately available:

"Telestroke networks should be deployed wherever a lack of readily available stroke expertise prevents patients in a given community from accessing a primary stroke center (or center of equivalent capability) within a reasonable distance or travel time to permit eligibility for intravenous thrombolytic therapy."

ASA Recommendations for the implementation of telemedicine within stroke systems of care, 2013

In keeping with ASA recommendations, the D-H TeleNeurology program offers prompt, high-quality, real-time audio/visual patient evaluation and assessment, within 30 minutes for time sensitive cases and within 120 minutes for non-time sensitive conditions.

Time-sensitive conditions

  • Acute stroke with TLKW less than 4.5 hours
  • Acute stroke with TLKW between 4.5 and 24 hours
  • TIA with TLKW less than 4.5 hours
  • TIA with TLKW between 4.5 and 24 hours
  • Intracranial hemorrhage
  • Status epilepticus
  • Other rapidly progressive neurologic condition (e.g., myasthenic crisis)

Non-time-sensitive conditions

  • Acute stroke with TLKW greater than 24 hours
  • Mental status change not via toxic, metabolic, or infectious cause
  • TIA with TLKW greater than 24 hours
  • MS exacerbation
  • Seizure
  • Syncope
  • Bell’s Palsy
  • Migraine
  • Other neurologic conditions
Connected Care: TeleNeurology service

In addition to providing clinical care for patients requiring emergency neurological care, the D-H TeleNeurology team provides the following services:

  • Support and coordination for credentialing/privileging.
  • Program Implementation — An experienced and multi-disciplinary team comprising a project manager, clinicians, and technical professionals delivers a wide range of services throughout the planning and implementation process. A collaborative project plan, developed after contract signing, specifies responsibilities and timing for each implementation task.
  • Program Training — Clinical training is delivered to your staff to assure confidence in the Emergency TeleNeurology service and the partnership between Dartmouth-Hitchcock and your hospital.
  • IT support, including assistance with network configuration and equipment set-up and ongoing 24/7 support for technical issues.
  • Educational offerings for hospital staff.

Advantages of the D-H TeleNeurology Program

Please expand the following topic areas to learn more about the advantages of partnering with the D-H TeleNeurology Program.

Financial & Quality Impact

TeleNeurology contributes positively to finances, market position, and staffing management through:

  • Improved financial performance

    • Avoidance of transfers
    • Decreased length of stay and ancillary costs
    • Decreased need for physician/PA/NP backup call
    • Reduced staffing costs, decreased need for locums tenens
    • Low-cost coverage for hospitals with limited or no neurologist access
  • Improved physician life balance, retention, and recruitment

  • Increased capacity resulting from greater throughput

  • Improved quality measures and outcomes

    • Our physicians are patient- and hospital-focused while adhering to strict federal, state, and hospital-specific requirements.
    • Improved timeliness in door to t-PA for eligible patients
    • Improved timeliness in mean door-in, door-out time (time to transfer)
    • Emergency TeleNeurology physicians are licensed and credentialed in all states/hospitals where services are provided.
  • Competitive market advantage

Educational Resources

  • American Stroke Association

    According to the AMA, "Telestroke is one of the most successful applications of telemedicine, bridging disparities in acute stroke care by bringing experienced stroke experts to hospitals that often lack expertise in treating acute ischemic stroke (AIS) patients."

  • National Stroke Association

    The National Stroke Association (NSA) is able to provide you with the information and tools you need to prevent and treat stroke in your patients, no matter where you work along the continuum of stroke care.

Metrics of Success

The three most common conditions resulting in TeleNeurology consults are altered mental status, stroke and TIA. Although nearly 70% of stroke consults have been truly emergent, the transfer rate to DHMC was avoided for 90% of TeleNeurology consults in FY17.

Image: Graph of the Site Retention Rate for Dartmouth-Hitchcock TeleNeurology

Among those patients who presented with an acute stroke, D-H TeleNeurology's tPA administration rate is 15% vs. 2-5% national average in non-stroke center hospitals. Average time to video for time sensitive calls.

Image: TeleNeurology tPA Administration Averages

Commonly Asked Questions

Do D-H providers cover all consults?

In addition to D-H neurologist coverage of the TeleNeurology service, we have partnered with Specialists On Call (SOC), a national leader with more than 10 years of experience, currently providing Emergency TeleNeurology Services to more than 350 hospitals across the United States. SOC annually consults on more emergency neurology patient cases than any traditional bricks and mortar medical center in the country.

When can we request a TeleNeuro consult? Overnight? Holidays?

Yes, the service is 24/7/365 for emergency consults.

How do I connect to the cart?

Our D-H Telehealth Technology Team will secure all the connectivity to the cart. When it's time for the consult, the physician will call in and automatically be connected. If there are issues with the cart, the technology team is on call 24/7 to triage the issue.

Image: Timothy Lukovits, MD

Will I receive a copy of the consult note? What is the turnaround time?

Yes, a consult note will be faxed to the number provided at intake, within a 15-60 minute turnaround time. Please note: the service provider will call the attending on site directly after to discuss recommendations, etc.

How do the patient's images get to the neurologist doing the consult?

The technology team has set up an access point for the images to be sent using DICOM Grid. The images will be pushed from staff on site. The D-H Transfer Center will then redirect the images to the appropriate location.

What is the difference between "Emergency" and "General" service?

  • Emergency service is provided 24/7 by a board-certified neurologist for patients who present with emergent conditions that should not wait for a regularly scheduled consult.
  • General service refers to scheduled consults for all non-emergent neurologic conditions provided by board-certified neurologists.

Contact information

For more information about the TeleNeurology Program at Dartmouth-Hitchcock, please contact:

  • Non-clinical questions

    Katelyn A. Darling

    TeleNeurology Program Manager, Connected Care
    Email: Katelyn.A.Darling@hitchcock.org
    Phone: (603) 650-1317
    Fax: (603) 727-7462

  • Clinical questions

    Keith McAvoy, MD, MA, FAAN

    Neurology Section Chief, Manchester Division
    Medical Director, TeleNeurology Program at Dartmouth-Hitchcock
    Email: Keith.J.McAvoy@Hitchcock.org

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