His name is M.A.C.S., short for Mobile Access Consultation Services, and he’s the newest tool in Northside Hospital-Cherokee’s effort to become a primary stroke center.
The sight of a 5-foot, wireless, remote-presence robot cruising along the halls of the emergency department initially catches some patients off guard, but not the staff.
“We think he’s pretty cool and [we] welcome the sight of him because we know that he isn’t taking the place of anyone, but bringing us something that we’ve never had — neurology 24/7,” said Karen Newman, RN, BSN, emergency department nurse clinician at Northside Hospital-Cherokee.
Stroke specialists live by the rule that “time is brain,” meaning that the sooner a patient with stroke symptoms can be assessed, tested and diagnosed, the sooner he or she can receive life-saving or life-changing treatment, such as the clot- busting drug tPA. In many of Georgia’s rural areas, stroke patients don’t have access to specialists or best practices because they live too far from a stroke-ready hospital.
“We’re the only hospital in Cherokee County and [we] also serve the communities north of us in Pickens County, but we’re a smaller institution,” said Jan Johnson, RN, MSN, chief nursing officer at Northside Hospital-Cherokee. “We have 84 beds and one neurologist on staff. Obviously, he can’t provide his services 24/7.
“We had heard that the technology for teleneurology was out there and [we] began exploring that as a way of giving our patients access to better care. We’re very excited about the robot.”
Hospital officials ordered the robot, which was developed by InTouch Health, in July. The staff and EMS technicians were trained to use it, and it was up and running by August.
“There has been a very positive response. The EMS technicians bring patients with stroke symptoms here now, instead of having to transport them farther away,” Johnson said.
M.A.C.S. stays plugged in at the hospital’s emergency room, but his operators are physicians from AcuteCare Telemedicine, a practice of board-certified neurologists who serve on the staff of Northside Hospital in Atlanta.
AcuteCare Telemedicine adopted the new technology two years ago as a novel way of expanding its practice into areas with a need for neurologists. Access to specialists at any time, day or night, provides remote hospitals with a more comprehensive level of care.
“We started by providing our services to a suburban hospital on the Southside. Northside Hospital-Cherokee is the second hospital in the state to use M.A.C.S.,” said Dr. Keith Sanders, with AcuteCare Telemedicine. “It’s not just a camera on a stick, but a sophisticated tool designed to gather information.”
When a patient with stroke symptoms enters the emergency department, physicians can call a designated number to consult the Atlanta neurology team.
“Instead of taking 30 minutes or more to drive to the hospital, I can log in within one or two minutes of the call,” Sanders said. “I’ve even been able to pull over and work from my car.”
Using a laptop, joy stick and headset, the physician drives the robot to a nurses’ station or a patient’s room to perform a stroke evaluation.
“Once you’re comfortable using the technology, it’s no different than assessing a patient in person,” he said. “I can take a history, zoom in to look at a patient’s pupils, perform the NIH [National Institutes of Health] stroke scale exam and swivel around to talk to the family.”
He can also pull up CAT scans and bloodwork and then confer with an ER physician to prescribe treatment.
“Stroke can mimic a lot of other things and emergency room staff is more comfortable making a diagnosis with input from a neurologist,” Sanders said. “Studies have shown that neurologic diagnoses are just as accurate remotely as they are in person. The ER nurses are a critical piece of the process, because they serve as facilitators and can do the physical things that we can’t do remotely.”
In mock drills, nurse clinician Newman trained the staff to use the robot.
“We had to be comfortable with it in the room so that we could make our patients comfortable with it,” she said. “When the physician beams in, his face is the same size it would normally be, and he can talk with the patient in real time. Once they get over the mouth-hanging-open surprise and the doctor starts talking, most patients forget about the machine.”
Staff named M.A.C.S. in a hospital-wide contest.
“We’re just glad that it allows us to treat stroke patients better and faster,” Newman said.
Sanders believes that more rural hospitals in the state will use telemedicine in their battle to combat stroke, which strikes about 20,000 Georgians a year, according to the Georgia Coverdell Acute Stroke Registry. The 30- to 40-minute delays caused by having to transport patients to stroke-ready hospitals are too costly, he said. Best practices require that stroke and heart attack patients receive treatment within 60 minutes of arrival in the emergency room.
“Metro Atlanta keeps sprawling and the traffic is terrible, but thanks to [wireless technology], we’re all closer,” Sanders said.
