Time is of the essence when it comes to treating stroke victims and other critical-care patients. Often that means making quick decisions about sending a patient to another facility if there’s no doctor onsite when the patient comes in.
To connect physicians to patients in outlying areas, Plaza Medical Center of Fort Worth rolled out the ‘doc bot,’ a robotic communications system that lets a doctor see and interact with a patient elsewhere. The technology adds a layer of personal treatment, letting the doctor actually see the patient as well as their diagnostic tests, said Sharon Eberlein, Neuroscience Program Director.
“Stroke specialists, such as the neurologists and neurosurgeons, are required to take calls in the hospital’s emergency department,” Eberlein said. “These busy physicians are often tied up in the OR, in their clinic or elsewhere and cannot immediately go to the ED. That results in long delays for patients and overcrowding for the hospital. Remote-presence technology enables our specialists to efficiently respond to an ED call at the point of care, whenever they are needed, day or night.”
The new technology enables a physician to perform key activities. He/she can discuss a patient’s status at the nurses’ station, “drive” into the patient’s room, observe the patient, check bedside monitors and ventilator settings, discuss care with the patient and/or family members and then return to the nurses’ station to give orders or discuss next steps.
“It gives our physicians that five minutes of actually looking at a patient, doing a brief neurological exam while they’re pulling up scans,” she added. “The robot can pull up the CT scan, and then the physician can draw on specific areas of the CT via remote access to show the patient and family the exact location of the infarct or hemorrhage. It allows the physician, patient and family to interact right away.”
The robotic bedside visit also lets the doctor make a faster, more informed decision about how to treat the patient, and what the next few hours should bring. That can mean a transfer to a larger facility, or a drive out by the doctor for an actual physical consultation.
“It helps to build that relationship, and really eases the minds of the patient and family,” Eberlein said. “It gives the family a sense that they’re not being ignored. When the patient comes into the ER, they see a physician and often get a battery of tests, but then it may be a while before they see another physician. This really makes a difference because they are seeing another doctor right away, and they feel like they are getting started on their treatment and recovery. And if they are going to be transferred, they are told when they’ll see the doctor once they get here. It really does make a world of difference to those patients in rural hospitals.”
The use of robots and cameras is a tremendous asset to any stroke system of care, as it allows ERs in rural as well as urban areas to reach neurovascular specialists for the rapid triage and management of patients with brain attacks.
It also improves the quality of care and patient safety by allowing the physician to be more available at the time of need. That can decrease complications for patients in areas of high acuity like the critical-care unit, as well as aid in time-sensitive treatment decisions for emergencies such as stroke care.
For Plaza Medical Center, the “doc bot” came up as an option during conversations Eberlein had with her counterparts at the other North Texas Division hospitals. Now 12 facilities are using either an RP-7 robot from InTouch Health, which can be controlled by its operator from a laptop and a joystick, or a cart with most of the robot’s features, but without the remote control.
“We trained all of the neurological unit nurses, everything from how it charges and has to be cleaned to all of its features,” Eberlein said. “We also worked with our ER physicians so they would know how they would interact between the doctor on the robot and how to introduce it to the patients.”
There was some initial concern that patients might not take to the “doc bot,” but that hasn’t been the case.
“They really don’t look at the robot, but rather at the physician’s face on the screen,” Eberlein said. “They are focused on what he or she is saying as opposed to the mechanics of the robot in front of them.”