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Published on May 03, 2018

Telemedicine Brings World-Class Care to Local Emergency Department

Photo of Sarah Phelps - Telemedine Stroke patient with MidMichigan Health and Michigan Medicine.When Sarah Phelps had a stroke, she went from being a health care professional to a critical patient. In less than an hour, Phelps was evaluated by a stroke team in Ann Arbor thanks to telemedicine.

Sarah Phelps is a registered nurse case manager for MidMichigan Medical Center – Midland. When she woke up with a headache on January 31, she had no idea she would be treated for a stroke before the day ended. She never suspected she would be examined by world-class experts while in her own Medical Center’s Emergency Department.

“I wasn’t feeling well all day,” the 38-year-old Phelps said. “I had a severe headache and dizziness off and on since early morning.” During an afternoon meeting, the head pain became unbearable.

“I knew something was wrong when I tried to take off my glasses and they fell out of my hands,” she said. By the time the meeting ended, her left side was numb and hard to move. She dragged herself along the walls, desperate to find her friend and colleague Dana Mahoney, R.N. “When I saw her at the nurses’ station I started crying because I couldn't talk, but she knew right away I was having a stroke.”

At that moment, Phelps said she stopped being an employee. “I went from being an employee to a critical patient,” she said.

Mahoney immediately called the Emergency Department and told them she was bringing in a possible stroke patient. Once there, Danielle Graham, D.O., took over Phelps’ care and called for Critical Stroke protocol.

“I was sent for a CT scan almost immediately and they had the results within 10-15 minutes,” she said.

The scan showed that Phelps had suffered an acute ischemic stroke due to bilateral vertebral artery dissections, or tears in the arteries on both sides of her neck that restricted blood flow to the brain. While not common, this type of stroke accounts for 10 to 25 percent of strokes in patients 45 or younger. Most patients experience stroke symptoms; fortunately, more than 75 percent make a full recovery.

While Phelps was having imaging done, the emergency team was setting up equipment for a telemedicine consult with Neurologist Mollie McDermott, M.D., M.S., medical director, Comprehensive Stroke Program, at Michigan Medicine in Ann Arbor.

“Dr. McDermott talked with Dr. Graham and me and did an assessment,” Phelps said. “I was having a difficult time getting the words out – there were lots of yes and no questions – but I was very aware of everything going on.”

“Telemedicine is the coolest new technology I have seen in a long time,” Phelps said. “To have that specialist right there with me when I needed them was amazing.”

Tom Wood, M.B.A., B.S.N., R.N., director of trauma and telehealth, said Phelps is just one of the hundreds of stroke patients who have benefited from telemedicine at MidMichigan Health.

“Michigan Medicine is our stroke partner,” Wood said, adding that a consult with Michigan Medicine specialists is part of the protocol for assessing and treating stroke patients at MidMichigan Health Emergency Departments.

“While Sarah’s story takes place in Midland, the service is available everywhere we have an Emergency Department1. If she had been in Gladwin or Alpena or Clare, she still would have had access to that same world-class care because of telemedicine.”

Wood defines telemedicine as the use of technology to provide health care remotely. “The best people, processes and technology make it work,” he said. “From a technical standpoint, telemedicine is much more than just a video chat. In some cases, a laptop with a camera is all we need but with stroke, we need a higher quality and we have top of the line equipment.”

The dedicated telemedicine equipment includes a high-definition video camera that the physician on the viewing end can control, and another camera specifically for extreme close-up views. “It even has a stethoscope so the doctor in Ann Arbor can listen,” Wood said.

“Telemedicine lets us deliver world-class care to communities that never had access before,” Wood said. “You can go to any MidMichigan Health Emergency Department and you get the same stroke treatment as if you had walked in the ER in Ann Arbor. That’s the beauty of telemedicine – it eliminates the need for everything to happen at a particular location.” 

Woods added that a $494,900 rural telemedicine grant from the United States Department of Agriculture (USDA) awarded to MidMichigan in 2015 helped lay the foundation for the expansion of MidMichigan’s telemedicine program. MidMichigan’s project was one of three selected in Michigan and one of 75 awarded nationwide.

Dr. McDermott and Dr. Graham decided to have Phelps transferred to the stroke care unit at Michigan Medicine. “Ms. Phelps' case was very complicated, and the teamwork between MidMichigan Health and Michigan Medicine was essential in providing her timely and appropriate care,” Dr. McDermott said. “The Michigan Medicine team was able to evaluate Ms. Phelps over video, and then meet her in person, which was a very rewarding experience. Ms. Phelps is a special person and a member of the MidMichigan Health/Michigan Medicine family, and we are honored to have been part of her care.”

Phelps actually suffered a second stroke and was re-admitted to Michigan Medicine. “My recovery has been phenomenal because they recognized and treated the initial stroke so quickly,” she said. Finding the root cause of the strokes has proved challenging, but Phelps remains hopeful. “I had scans every couple of weeks to make sure it was healing and now they can’t see the dissection anymore.” Following the advice of her health care team, she is closely monitored and will undergo further evaluation and genetic testing. “I also rest and try to keep stress under control.”

For more than a month, Phelps had physical therapy and occupational therapy sessions each week, with speech therapy scheduled for the future. She said doing therapy four times a week, following up with her health care team and raising her 10-year-old son is challenging but rewarding. “I do have some deficits, some numbness, but I have strength, and I can walk and talk,” she said. “I think it would have been much more debilitating if I hadn’t been monitored so closely. The second stroke would have been much worse.”

Phelps knows that she was critically ill and that the outcome could have been completely different. She still marvels that even though she was in the middle of the state, two hours away from Ann Arbor, she was examined and evaluated by a world-class expert at the University of Michigan – all within 60 minutes of arriving in emergency.

“I was at the best possible place to have a problem,” Phelps said. “They used all the right resources and there was no stopping the teamwork. It was absolutely amazing.”

The Neurology and Acute Stroke Program is just one of the telemedicine programs available through MidMichigan Health. Learn more at www.midmichigan.org/telemedicine.

1MidMichigan Medical Center – West Branch is new to the MidMichigan family and will be getting telemedicine access to the Michigan Medicine Stroke team in the future.

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