MCG REACH Telestroke sites in Georgia If you roll over and click on this dot on this georgia map, it will take you to the Cobb Memorial Hospital website If you roll over and click on this dot on this georgia map, it will take you to the Elbert Memorial Hospital website If you roll over and click on this dot on this georgia map, it will take you to the Morgan Memorial Hospital website If you roll over and click on this dot on this georgia map, it will take you to the Washington County Regional Medical Center website If you roll over and click on this dot on this georgia map, it will take you to the Tift Regional Medical Center websiteIf you roll over and click on this dot on this georgia map, it will take you to the Emanuel Medical Center websiteIf you roll over and click on this dot on this georgia map, it will take you to the Jenkins County Hospital websiteIf you roll over and click on this dot on this georgia map, it will take you to the Jefferson Hospital websiteIf you roll over and click on this dot on this georgia map, it will take you to the McDuffie Regional Medical Center website If you roll over and click on this dot on this georgia map, it will take you to the Wills Memorial Hospital website If you roll over and click on this dot on this georgia map, it will take you to the Doctors Hospital website

MCG Stroke/Telestroke Network

In February, 2003, a novel telestroke “hub and spoke” network (REACH) was devised by a group of doctors in the Department of Neurology at MCG. The goal of REACH was to overcome geographic disparities in acute stroke care and extend state of the art stroke therapies to patients living in rural East Central Georgia by providing acute telestroke consultations to emergency departments in underserved areas.

This network has grown from the initial two rural sites at Emanuel Medical Center in Swainsboro, Georgia and McDuffie Regional Medical Center in Thomson, Georgia to comprise a total of eleven hospitals throughout the state (see Figure above). The nine original hospitals are located between 32.5 and 102.8 miles from the “hub” at MCG, with mean hospital size of 49 beds, an annual ED volume of 7,602 patients and approximately 50 (ischemic and hemorrhagic) strokes per year. Most of the hospitals are located in counties with a significant minority population. More recently, larger hospitals, Tift Regional in Tifton, Georgia and Doctor’s Hospital in Augusta, Georgia, have been added to the network.

The Technology

REACH is activated when an emergency medicine physician within the network suspects that a patient is suffering an acute ischemic stroke and may be a candidate for intravenous tPA. A call is placed to the Emergency Communications Center at MCG where an operator pages the on-call REACH consultant. Four neurologists specializing in stroke and one emergency medicine physician share 24 hours per day, 7 days per week call responsibilities. Responding to the page, the consultant is connected via telephone with the referring physician to obtain history and talk with the patient and family (see the REACH Triangle figure).

Triangle depicting the relationship of Doctor to Rural Hospital to Main Hospital in the treatment of Stroke via the REACH Telestroke technology

Simultaneously, the stroke consultant logs-on to the REACH system from any computer with high-speed internet capabilities. The patient can be visually assessed from a camera mounted on the REACH cart within the patient’s room in the local hospital, allowing for direct evaluation and scoring of the severity of neurologic deficits using the NIHSS2 (see the REACH cart photo, below). Vitals signs, capillary blood glucose and laboratory values are accessible to the consultant.

The CT scan images are transmitted via the REACH system and reviewed by the consultant (see the REACH screen photo, below). A decision in support of or against the administration of tPA is made based on nationally recognized guidelines.

 

this pair of pictures shows the REACH station and a representative image of the information on the monitor when the program is active

If a recommendation is made to proceed with treatment, weight-based dosage including bolus and infusion are printed on a consult delivered to the rural hospital. Following the initiation of treatment, patients are transferred to MCG where they may be evaluated for additional reperfusion therapies and monitored for tPA-related complications. Written informed consent (as specified by the Institutional Review Board of MCG) is then obtained from the patient or legally authorized representative before any follow up with the subjects can be initiated.

Representative Publications

  1. Wang S, Lee SB, Pardue C, et al. Remote evaluation of acute ischemic stroke: reliability of National Institutes of Health Stroke Scale via telestroke. Stroke 2003;34(10):e188-91.
  2. Wang S, Gross H, Lee SB, et al. Remote evaluation of acute ischemic stroke in rural community hospitals in Georgia. Stroke 2004;35(7):1763-8.
  3. Hess DC, Wang S, Hamilton W, et al. REACH: clinical feasibility of a rural telestroke network. Stroke 2005;36(9):2018-20.
  4. Gross H, Hall CE, Wang S, et al. Prospective reliability of the STRokE DOC Wireless/Site Independent Telemedicine System. Neurology 2006;66(3):460.
  5. Hess DC, Wang S, Gross H, Nichols FT, Hall CE, Adams RJ. Telestroke: extending stroke expertise into underserved areas. Lancet Neurol 2006;5(3):275-8.
  6. Gross H, Hall C, Switzer JA, et al. Using tPA for acute stroke in a rural setting. Neurology 2007;68(22):1957-8; author reply 8.
  7. Switzer JA, Hall C, Gross H, et al. A Web-based Telestroke System Facilitates Rapid Treatment of Acute Ischemic Stroke Patients in Rural Emergency Departments. J Emerg Med 2008.

 

Revised December 10, 2008.   Please send comments, suggestions or questions about this page to Neurology Web Page Manager: Michael Jensen, mjensen@mcg.edu .