Telemedicine specialists reach Nevada County stroke patients faster |

Telemedicine specialists reach Nevada County stroke patients faster

Gary Cooke
Special to The Union

If you call and order a pizza, you probably won't hear your doorbell ring for at least 20 or 30 minutes.

But if an ambulance delivers you to the emergency department at Dignity Health Sierra Nevada Memorial Hospital (SNMH) and doctors think you're having a stroke, they will have a specialist in neurology at your bedside in an average of six minutes. That specialist will be ready to discuss the case with ER doctors, observe and talk with the patient, order tests, review results on the spot, and guide the delivery of life-saving medicine.

The specialist is not physically in the room, but he or she might as well be. This is telemedicine in action.

When it comes to stroke patients, minutes can mean the difference between living and dying, or in limiting brain damage that could impact a patient's ability to function normally for the rest of her life.

"Damage to the brain during an acute ischemic stroke is a rapid and progressive process," according to Marie Daly, RN, BSN, stroke program coordinator at SNMH. "Stroke is the fourth leading cause of death in the United States and a leading cause of major disability."

The benefit of having a neurologist on the case swiftly is to provide a timely assessment of the patient's neurologic function and collaborate with the local physician to determine the appropriate care.

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As a benefit of its affiliation with Dignity Health, the hospital is part of the Dignity Health Telemedicine Network, which provides access to 13 neurological specialists in the Greater Sacramento area who provide coverage 24 hours a day.

Here's how it happens, according to Jim Roxburgh, network director.

"A local site like Sierra Nevada Memorial calls our transfer center, which pages the neurologist on call. In a review of 1,700 cases the average time it took for the neurologist to check in with the center was two minutes. In less than ten minutes, the neurologist was hooked up remotely with the requesting physician and observing the patient."

The neurologist "beams in," or in other words, the patient sees the neurologist's face on the computer screen and is able to have a two-way conversation.

"Initially, this catches the patient by surprise," Roxburgh says, "But in a matter of seconds, the patient realizes that he is speaking with the neurologist just as if the neurologist is at the bedside! Patients appreciate being able to have the specialist at their bedside right away."

"Patients and their families are very receptive and impressed with the telemedicine technology and interaction with the neurologists," Daly confirmed. "The wireless technology gives the doctor the information needed to make the most informed decision for immediate management of the patient's condition."

Access to specialized help like this is one factor in the designation of SNMH as an Advanced Primary Stroke Center. But an entire rapid response team is required to care for each stroke patient, Daly noted. The team at SNMH is headed by Dr. Kuldip Gill, medical director of stroke services, and includes Emergency Department physicians and nurses, the laboratory, radiology, ultrasound, and cardiology units, the telemetry nursing unit, and the Physical, Occupational and Speech Therapy Department.

Quick action at the hospital makes a crucial difference for stroke patients, but recognizing stroke symptoms and getting emergency help are equally vital, Daly said. National stroke organizations have developed the FAST system to help identify possible stroke victims:

F – Face: Ask the person to smile. Does one side of the face droop?

A – Arms: Ask the person to raise both arms. Does one arm drift downward?

S – Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?

T – Time: If you observe any of these signs, call 9-1-1 immediately.

May has been designated as National Stroke Awareness Month. For more information about strokes, visit the National Stroke Association website at To schedule stroke education at your community organization, contact Marie Daly at 530-274-6771 or

All physicians providing care for patients at SNMH are members of the medical staff and are independent practitioners, not employees of the hospital.

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