BHB trans-oceanic telestroke service with Johns Hopkins

Thursday 22 July 2021: The Bermuda Hospitals Board (BHB) Primary Stroke Centre is one of the first facilities in the world to offer a trans-oceanic telestroke service. The service is provided through a collaboration with Johns Hopkins Medicine International (JHMI).

Telestroke allows experts anywhere in the world to quickly examine a suspected stroke patient and make the time-sensitive treatment recommendation that can mean the difference between full recovery and permanent disability or death.

“BHB started a local telestroke service internally between Emergency Department physicians, hospitalists and local neurologists,” explained Dr Francene Gayle, BHB consultant neurologist and Primary Stroke Centre medical director. “Then in December 2020, the telestroke service became trans-oceanic, connecting with Johns Hopkins.

“Not even a pandemic stopped our teams from moving ahead with plans to advance the service. We have up to five patients a week who come to the hospital having suffered a stroke whether there is a pandemic or not, so continuing to develop our services in the Primary Stroke Centre has been so important to the whole team working on this initiative at BHB.”

“This innovate way of managing stroke patients helps us collaborate in real time to care for our patients, despite being over 800 hundred miles apart,” said Dr Victor Urrutia, director of the Johns Hopkins Hospital’s Comprehensive Stroke Center. “Time is one of the most important factors in stroke treatment, so being able to collaborate remotely and make critical decisions about care makes a huge difference in outcomes for the individual patients.”

When the local telestroke service began in June 2020, about 8% of ischemic stroke patients received IV thrombolysis treatment – a significant improvement on the numbers given the drug before the Centre launched. After JHMI neurologists joined the local telestroke team in December 2020, the proportion of stroke patients who were administered the drug continued to rise to 13%. The average for primary stroke centres in the US is 7%.

The benefit is not just for those treated on island, however, but also for those who would benefit from treatment overseas.
“Most recently, we had our first trans-oceanic transfer from BHB to a comprehensive stroke centre in the US for the removal of a large clot that had blocked a major blood vessel in the brain, a procedure called mechanical thrombectomy,” Dr Gayle explained.

“Timing is critical in these cases, as the patient needs to be at the overseas hospital within 16 hours of the start of symptoms. BHB is engaging with the insurance companies to ensure that our airvac turnaround times are efficient in order for us to meet the transfer process within 16 hours,” said Dr Gayle. “We are quite thrilled about this.

“While this overseas relationship has clear clinical benefits, we have to stress the importance of recognising the need to get to hospital immediately if an individual thinks they have had a stroke. We have the clinical processes in place to act quickly, but this can only happen if people get to the hospital in time, so remember the BEFAST acronym – balance, eyes, face, arms, speech and time – to quickly identify and act on the early warning signs of a stroke.”

“We are honoured to collaborate with BHB to improve the care of stroke patients in Bermuda,” concluded Dr Urrutia. “The telestroke work we have done not only benefits people in Bermuda, but has far reaching implications for other remote area facilities. The experiences we gain through this collaboration can be shared globally.”

Editor’s note:

• About the BHB Primary Stroke Centre: Established in July 2019 as part of a clinical affiliation with Johns Hopkins Medicine International, the BHB Primary Stroke Centre focuses on improving treatments and processes within the hospital, as well as providing education to help the community identify stroke symptoms to ensure timely treatment, and know the risk factors that can help reduce the incidence of stroke altogether.
• About strokes: Ischemic stroke patients with smaller blockages are also experiencing better outcomes since the telestroke service began. IV thrombolysis is the procedure by which stroke patients receive a drug to dissolve or breakup the clot or blockage in the blood vessel that is restricting the flow of blood and oxygen to the brain. Administering the drug quickly increases the chance of the patient recovering from the stroke with little or no disability at all.
• Strokes in Bermuda: There are up to five strokes every week in Bermuda, and 25% of strokes in 2020 were in people under 60. Seventy-three percent of strokes are in Black people, 24% are in white people and 2% are in ethnicities classified as ‘other’.

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