Telehealth

St. Catherine Hospital Emergency Room Director Dora Leon uses a computer to call a neurologist to consult on a patient who might be having a stroke.

GARDEN CITY — When Christi Graber checked into the St. Catherine Hospital emergency room late last year, she thought she was having a heart attack.

Her left arm ached, she felt dizzy, and she experienced shortness of breath.

The hospital’s cardiologist wasn’t available that night or for the next three days, so Graber had two options: Travel by ambulance to see a cardiologist more than two hours away in Hays during a snowstorm; or simply go home. Ultimately, she and her husband drove home.

They worried both about the weather and the cost.

“That’s a huge expense to be taken by ambulance a few hours away,” Graber said.

Even the largest hospitals in the rural counties of western Kansas struggle to hire cardiologists and other specialists. Instead, they often transfer patients to Wichita, Denver or Kansas City.

Now those same hospitals increasingly bring in specialists with virtual hook-ups, beaming in doctors from South Dakota who direct treatment over ever-more-elaborate video calls to emergency rooms in Garden City or Goodland.

Yet for all the solutions telemedicine might offer, its obstacles range from iffy internet connections to uncertainties about insurance coverage to simple technophobia.

Emergency room telemedicine

If someone suspects they are having a stroke or heart attack, getting to an emergency room in time is critical.

But a visit to a rural emergency room that doesn’t have a cardiologist or neurologist can lead to a transfer by ambulance or air to a metropolitan-area hospital with specialists on hand.

Several frontier counties — areas that have less than six people per square mile — comprise the northwest corner of Kansas. Two critical access hospitals serving the area, Rawlins County Health Center and Goodland Regional Medical Center, have tailored their emergency rooms for telemedicine.

Goodland Regional Medical Center and Rawlins County Health Center both contract with Avera eCARE, a virtual hospital that works with 22 critical access hospitals in Kansas. When doctors in those hospitals need more expertise, they connect by video to Avera’s specialists.

Ronald Robinson, a physician and CEO of the Goodland and Rawlins County hospitals, said pulling in the right specialists can make all the difference in a complicated case. Telemedicine, he said, makes that more practical.

“The physician … can see the (electrocardiogram), see the monitor, see the patient and assist us in making sure that we’ve got that correct diagnosis,” Robinson said.

Doctors working remotely with ER patients can also assist bedside nurses and doctors with procedures, such as guiding them on putting in a breathing tube. Robinson said cameras mounted in emergency rooms allow doctors to see hospital equipment and walk staff through the process.

To begin a telemedicine call, someone simply presses a button.

“Directly above that,” said Brian Skow, an emergency medicine specialist and the chief medical officer of Avera eCARE , “there’ll be a 55-inch high-definition monitor and then a camera that’s attached to that to access our system.”

The Avera physician appears on the screen in 30 seconds or less, Skow said. Heart attack and stroke calls rank among the most frequent.

“We can determine if it truly is just stroke,” Skow said. “I can read the CAT scan of the brain so I can determine, yes, this would meet criteria for (a) clot-busting drug.”

Finally, the telemedicine service can assist with patients needing further treatment at trauma centers by arranging helicopter, ambulance and plane transfers.

At St. Catherine Hospital in Garden City, if an emergency room patient shows signs of a stroke, a mobile cart with a camera and computer screen wheels a remote a neurologist in to examine the patient.

“So if we have that accessibility,” said Dora Leon, a nurse who manages the emergency room at St. Catherine, “that makes us feel more comfortable knowing that if our ER doctor wants a little bit of backup, it’s there. It’s available.”

She said the mobile cart is placed at the foot of a patient’s bed so the neurologist sees the entire body when looking for signs of weakness.

The neurologist can view a patient’s medical information on another screen.

“We hold their arm up, and see how long they can hold it up. (Then), their leg. It’s just to check which side of the brain is affected by the stroke,” Leon said.

All the while, a neurologist, the sort of specialist that St. Catherine doesn’t have on staff, can examine the patient in those critical early moments when a possible stroke’s been detected. And when the right treatment matters most.

Celia Llopis-Jepsen, reporter for KCUR 89.3 FM, contributes to the Kansas News Service, a collaboration of KCUR, Kansas Public Radio KANU 91.5 FM and High Plains Public Radio, which provides stories to local newspapers statewide.

For more information, visit ksnewsservice.org. Llopis-Jepsen can be reached via celia@kcur.org.

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