Top Hospitals and Healthcare 2016: Bon Secours St. Mary’s delivers faster care to stroke victims with teleneurology.
Amandeep Sangha, M.D., medical director of St. Mary’s Comprehensive Stroke Center.
A patient arrives to the emergency room at Bon Secours St. Mary’s Hospital in Richmond with symptoms of a stroke, perhaps paralysis on one side of the body or slurred speech. As doctors and nurses tend to the patient, the neurologist arrives to the scene—on a high definition monitor.
While some families might be taken aback at first by teleneurology, once they hear about the benefits, “They’re perfectly ok with it,” says Dr. Amandeep Sangha, a neurologist and medical director of the Stroke Program at Bon Secours St. Mary’s.
AcuteCare Telemedicine, based in Atlanta, provides the round-the-clock service for all five Bon Secours hospitals in Richmond. The four board-certified neurologists on staff have a combined 50 years of experience, and offer a response time of less than two minutes.
“That’s what really matters when it comes to acute stroke care. Time is of the essence,” says Sangha. “We’re losing several million brain cells every minute. The longer we wait, the more brain damage will occur, and then it will be to the point where you cannot retrieve it.”
The remote specialist reviews the patient’s history and conducts a neurological exam. Via joystick, the provider can zoom in and out, even examining the patient’s pupils. The specialist can review electronic records, lab results and CT scans, and order clot-busting t-PA drugs, generally if the stroke occurred within the previous three hours. If more time has passed, usually up to a maximum of six hours, the teleneurologist can refer the patient to interventional neurology, where a radiologist can dissipate the clot by catheter.
Afterwards, in the ICU, the patient will receive a visit from a St. Mary’s neurologist within 24 hours. Other team members involved in the care include a physical therapist, occupational therapist and speech pathologist. The patient may receive a referral to a rehabilitative or skilled nursing facility, make follow up visits to the neurology clinic, and take part in a stroke support group.
St. Mary’s exceeds national benchmarks for acute stroke care—for instance, 100 percent of stroke patients who qualify for IV t-PA will receive it, compared to the national performance goal of 85 percent. In 2016, St. Mary’s was one of only two hospitals in the state to be named a Joint Commission American Heart Association Comprehensive Stroke Center.
In most community hospitals, neurologists are on call, and it may take them 30 minutes to an hour to arrive bedside, says Sangha. “This is one of the reasons why teleneurology came into existence. You can’t match having the physician looking at the patient within a few minutes of the call.” Neuro.Richmond.BonSecours.com
Neurosurgery News
HCA Virginia’s neuroscience center at Johnston-Willis Hospital in Richmond celebrated its 3,000th gamma knife procedure in May. For more than 12 years, the hospital has been utilizing gamma knife technology to provide brain cancer and tumor patients with this type of advanced radiation therapy, which can be performed on an outpatient basis and has minimal impact on surrounding healthy tissue.
Last summer, the U.S. Food and Drug Administration approved the first focused ultrasound device for treating essential tremor. Dr. Jeff Elias of the UVA School of Medicine led an international clinical trial to demonstrate the safety and effectiveness of using the scalpel-free technology to treat essential tremor, which is the most common movement disorder.
Last spring a team of two dozen medical professionals at the Inova Health Neuroscience and Spine Institute, including surgeons, neurologists, radiologists, anesthesiologists and imaging experts, joined forces to perform brain surgery inside an MRI scanner on a patient suffering from Parkinson’s disease. This is the first time that this surgery has been performed using an MRI scanner and while a patient was asleep. Parkinson’s patients anxious about staying awake during the operation now have a second option for this procedure—the equivalent of receiving a pacemaker for the brain.
Neurosurgery Top Honors 2016
Centra Lynchburg General Hospital Lynchburg, CentraHealth.com, 434-200-3000 Sentara Williamsburg, Sentara.com, 757-984-6000 HCA Johnston-Willis Richmond, HCAVirginia.com, 804-330-2000 LewisGale Regional Health System Salem, Alleghany, Montgomery and Pulaski, LewisGale.com, 540-776-4000 VCU Medical Center Richmond, VCUHealth.org, 804-828-9000
See all of our top hospitals for 2016, below.
Cancer LewisGale Regional Cancer Center UVA Cancer Center
Cardiology VCU Pauley Heart Center
Dermatology Inova Melanoma and Skin Cancer Center
Diabetes EVMS and Sentara Heart Hospital
Gastroenterology Centra Lynchburg General Hospital
Geriatrics Riverside Center for Excellence in Aging
Orthopaedics Carilion Clinic
