Meeting Patients Where They Are: Mercy Virtual Closes Gaps in Care

The following article is from Arkansas Hospitals magazine, a custom publication of Vowell, Inc., which also produces Arkansas Money & Politics.

by Jennifer Cook, Senior Media Relations Specialist, Mercy

Trey Auten was taking a break during a bike ride last fall when he began to feel strange. His right arm and leg were weak, and his vision faltered. Still, when the friend he was riding with said it was time to go, he struggled to put on his helmet and continued.

A few minutes later, as they neared an intersection, Trey’s bike wobbled, and he fell over.

“I remember falling over, but I didn’t even know I was going that slowly,” he said.

Auten was also unaware that he was suffering a stroke. And from that moment, the clock was ticking because parts of the brain begin to die when stroke cuts off its blood flow.

His wife, Lisa, rushed to the scene to transport him to Mercy Hospital Northwest Arkansas in Rogers. Immediately, Auten was taken for a CT scan. Though they didn’t know it, a “virtual neurologist” would quickly be reviewing Trey’s information remotely using technology Mercy calls TeleStroke.

At age 50, Trey wasn’t a typical stroke patient, but many symptoms, including his increasing confusion in the emergency department, pointed to stroke.
After looking at Trey’s scan, vital signs and information from emergency department personnel, the neurologist examined Trey via a TeleStroke cart, which allows physicians to “see” a patient virtually through a secure video connection and a camera so sharp and sensitive, it can detect changes in pupil dilation.

Within minutes, the neurologist diagnosed a stroke and determined that Auten was a good candidate for the so-called “clot-busting” drug tPA. After it was administered, medical personnel noted immediate improvement in Trey’s limb movement and speech.

The sooner tPA is given, the better chance a patient won’t suffer long-term effects from a stroke, says Mary Tabor, Mercy’s stroke program coordinator in Rogers. That’s why a quick diagnosis through TeleStroke is so important.

WORLD’S FIRST VIRTUAL CARE CENTER

TeleStroke treatment and Mercy’s other modes of telemedicine are all coordinated through the world’s first Virtual Care Center in Chesterfield, Missouri. Opened in October 2015, the 125,000-square-foot building is the cornerstone of Mercy’s nationally-recognized program for delivering telemedicine.

Telemedicine is not just about technology, however. Developing the center also required investment in electronic medical records that physicians can access anywhere, as well as a highly trained workforce of caregivers. These resources were combined with cutting edge processes proven to improve patient care.

In addition to the TeleStroke service that was so essential to Trey Auten, some the other key programs delivered through the Virtual Care Center are:
TeleICU – For more than a decade, Mercy has operated the nation’s largest single hub electronic ICU, which employs advanced analytics and tested processes to collaborate with bedside caregivers for optimal patient care.
eSitter – This resource provides 24/7 observation for agitated or at-risk patients using two-way audio-video monitoring to improve patient safety and reduce stress on staff members.

TeleHospitalist – This program helps close gaps in clinician coverage that may sometimes occur overnight and at peak demand times, particularly in rural areas.

TeleSepsis – Using algorithms, data aggregation and centralized monitoring, this initiative is designed to ensure early detection and response to inpatient sepsis cases.

Engagement@Home – Providing tools to engage patients in their own care management, this program allows a multidisciplinary team to care for the health system’s sickest patients in their homes under the direction of their primary care provider.

REMOTE PATIENT MONITORING

Recent legislative changes will enable Mercy to deliver the Engagement@Home program in Arkansas for the first time beginning this year. This groundbreaking program addresses seriously ill patients who must manage multiple chronic conditions and are at high risk for complications and frequent hospitalizations.
Patients enrolled in the program receive a tablet computer, blood pressure cuff, pulse oximeter and weight scale. Using advanced analytics, biometric monitoring and interactive technologies, a care team proactively monitors and engages the patients to provide them with individualized care and keep them healthier and out of the hospital.

During a 24-month assessment, Mercy found Engagement@Home reduced preventable readmissions by 50% and reduced medical costs by 30%. More importantly, 98% of patients indicated satisfaction with the program.

Mercy plans to have Engagement@Home up and running in Arkansas by fall, says Dr. Gavin Helton, medical director for ambulatory medicine at the Virtual Care Center.

Engagement@Home helps address the needs of patients who aren’t well-served by episodic care delivered during office visits.

“We’re bringing the right level of care at the right time, which many times is in the home,” Dr. Helton says. “The key is collaboration with the traditional care team. Using virtual care, we’re able to leverage technology to fill current gaps in care.”

Such gaps often occur when patients are transitioning from one level of care to another, he explains. That could be when patients transfer from the intensive care unit to a regular floor or from the emergency room to home. The Virtual Care Center focuses on being part of a continuum of care that helps create more seamless transitions.

“This makes it a system focused on patients, where their needs are driving what we do,” Dr. Helton adds.

FILLING NEEDS AND SAVING LIVES

Indeed, patient need was the driving force behind the initial development of TeleStroke. Stroke has become the fifth-leading cause of death in the U.S. and can lead to paralysis and loss of cognitive function in survivors.

There aren’t enough neurologists in the United States to offer the 24-hour coverage needed to ensure patients are diagnosed quickly enough for possible tPA treatment. That’s where the Virtual Care Center and TeleStroke program help fill the gap.

Because of quick diagnosis and treatment, Trey Auten has no lasting effects from the stroke he suffered in October. On the other hand, his health scare inspired some lifestyle changes, including following a low-sodium diet that has helped him drop 40 pounds.

“I’m kind of convinced this was a God thing and a wake-up call,” he says. Today, Trey is thriving in his work as a computer programmer, recently celebrated his daughter’s high school graduation and is considering a cautious return to bike riding.