Simulation Technology Supports VA National Telestroke Program
By David J. Adriansen, Ed.D, NREMT, CHSE
NTSP Director of Simulation
VA National Telestroke Program, Office of Rural Health
MINNEAPOLIS – The VA National Telestroke Program (NTSP) serves Veterans with acute stroke symptoms at VA emergency departments, urgent care centers and hospitals. Each year, approximately 4,500 Veterans are diagnosed with an acute ischemic stroke (AIS), according to the Office of Rural Health. Stroke is the fifth leading cause of death in the United States, and the leading cause of serious long-term disability.
Glenn Graham, MD, Ph.D, Telestroke Program executive champion and the original founder in 2017, explained that the program has grown in providing acute stroke expertise to VA facilities that lack around-the-clock acute stroke coverage. The NTSP is comprised of a virtual “hub” of VA stroke neurologists located around the country that participate in a 24/7, year-around call schedule to provide coverage to participating facilities. Sharyl Martini, MD, Ph.D, NTSP medical director, reported on the growth of the program with “22 Neurologists covering telestroke services for 38 VA facilities and 20 additional facilities forecasted to be added annually in FY2021-2023.”
When a Veteran with acute stroke symptoms presents at a participating VA facility, front-line staff use a mobile device to videoconference with the telestroke neurologist. The neurologist examines the patient, reviews the medical record and CT images, advises the local treating physician as to a diagnosis and recommended treatment and documents recommendations in the patient record. These recommendations are executed by the local treating provider.
Jane Anderson, NP, Ph.D, NTSP director of education, explained that, “before a VA telestroke facility activates telestroke services, the NTSP Team conducts a two-and-a-half day go-live course onsite, including three to four telestroke simulations.” The team, with the support of SimLEARN nurse faculty, uses standardized patients in simulation scenarios involving a patient presenting with stroke symptoms. Each simulation involves mobile technology and simulated waveforms on actual patient monitors to increase simulation fidelity. The patient is followed through initial diagnosis, communications with the telestroke neurologist, CT scan and medication administration.
According to Bill Cerniuk, NTSP chief of technology, the field of VA telemedicine continues to expand and is positively impacting care for our Veterans. VA Mobile Technology and Simulation supporting the Telestroke Program via virtual reality, serious gaming, artificial intelligence and standardized patients are helping reinforce provider learning and improve patient care. Please contact the NTSP Team at firstname.lastname@example.org or Katie Murphy, NTSP Program Manager (Katherine.Murphy@va.gov) for questions on the VA Telestroke Program.