University Hospital of North Norway brings acute stroke care closer to the patient in the
Mid-Troms district
The outcome of the innovative project can have great significance for the future treatment of acute stroke in Norway and abroad.
In regions with long distances to hospitals and many assignments for the air ambulance, it is challenging to get patients with stroke in time for treatment within 4.5 hours. Fast transport by air is not always possible. In bad weather conditions and many simultanious assignments, the patient must be transported by car, a journey that can take between two and four hours, all depending on the weather and the distance.
In case of suspected stroke, all patients in Mid-Troms have so far been transported to the University Hospital of North Norway in Tromsø for further examination and treatment. Statistics show that almost half of the patients arrive too late at the hospital to receive anticoagulant treatment effectively.
"A stroke can be caused by a blood clot or bleeding. If the stroke is caused by a blood clot, the treatment is anticoagulant medication called, thrombolysis. Before thrombolysis, we must always take a CT scan of the head to rule out cerebral hemorrhage. The consequence for the patient is often that one either does not reach the treatment that must be started within 4.5 hours, or that they arrive late when the effect is lowest."
Neurologist Section Chief Physcian
Project Manager University Hospital
North Norway
First District Medical Center in Norway with a CT
Finnsnes District Medical Center (DMS) is located in Senja municipality in the middle of Troms county, about 160 kilometers from Tromsø in the Northern Norway. It was the first district medical center with a CT machine in Norway when the installation took place in 2014. The CT is now utilized even more for life-saving stroke treatment in the region.
A new local telemedicine acute care for stroke has now been establish at Finnsnes. The new health service is a remote collaboration between emergency care and ambulance personnel at Finnsnes, and a neurologist, radiographer and radiologist in Tromsø. When the strike alarm goes off, the ambulance team decides in cooperation with the Medical Alarm Service, neurologist and emergency doctor what the fastest option is: Helicopter to the hospital in Tromsø or ambulance to the CT-lab at Finnsnes.
"We want to move the stroke care closer to the patient so more patients can be offered treatment, as well as receive the treatment at an earlier stage when the effect is highest. To achieve this, we use new working methods, new technology, and better interaction"
Early treatment essential in the treatment of stroke
In Norway, more than 10.000 patients are affected by stroke each year. The acute failure of blood and oxygen supply to an area of the brain is most often caused by a blood clot in a vein in the brain. The time before the blood supply is restored is decisive for the size of the damage, and affects both survival and future level of function, like talking or walking. Early treatment increases the chance of survival with good results after stroke.
The CT lab is transformed to a telemedicine emergency room with cameras and monitors
To rule out a cerebral haemorrhage, a CT scan of the patient's head must be taken. The CT machine is located at the district medical center at Finnsnes and is remotely controlled by a radiographer at the University Hospital in Tromsø. The clinical examination, decision-making and thrombolysis treatment are done in a video conference with a neurologist before the patient is transported to the stroke unit at the hospital.
The CT lab is equipped with many cameras from different angles so that the prehospital team can collaborate with the hospital specialists in Tromsø on both the clinical examination and the CT scanning.
New collaboration across the municipal health service and hospital specialists
In order to be able to move the treatment closer to the patients, new ways of working together - use of new technology and interaction between the municipality and the hospital - have been established. The goal is to reduce time, take faster decisions, start the treatment earlier and to get a common understanding among all the health care providers involved.
Professional developer Tina Isabell Aas from the Ambulance Service and her team have changed the routines and how they work in the prehospital team together with the specialists at the hospital when a stroke occur.
Sees that the patient's symptoms go away
- It feels great to participate in such an important project that can have enormous consequences for patients who have a stroke in our region. The fact that ambulance personnel are allowed to give stroke treatment locally is also motivational and meaningful for the work we do. With this treatment we can see that the patient's symptoms go away completely, says Tina Isabell Aas.
Click on the arrow in the media gallery to the right to see how the emergency ward staff are working together in the telemedicine CT-lab.
Impact on future acute stroke care treatment
The project is a collaboration between the University Hospital North Norway, District Medical Center at Finnsnes, Senja Municipality, University of Tromsø, Health North IKT and Siemens Healthineers. The results of the project can have great significance for the future organization of acute stroke treatment in the region, other regions in Norway and abroad.
The goal is to contribute to:
- Effective sharing of expertise and harmonization of surveys
- Reduction in time to make a diagnosis and start treatment
- Cost savings by reducing the number of air ambulance trips
- Utilization of resources and cutting-edge expertise in the region regardless of physical location
"Access to specialists is a limited resource also in Norway and very important in acute care cases such as stroke, where the shortest possible time for treatment is crucial. Siemens Healthineers participates in the project to evaluate how the syngo Virtual Cockpit solution can support remote control of patients with acute life-threatening symptoms where one does not have a radiological staff physically present"
Head of Diagnostic Imaging
Siemens Healthineers Norway