Once someone starts experiencing stroke symptoms the clock starts.
And when it comes to the number five killer and number one cause of disability, it's those minutes and seconds that make every difference.
Someone experiencing a stroke needs to be transported to the hospital then sometimes transported from there to a specialized hospital where doctors are capable of performing a minimally invasive therapy - a physician inserts a catheter into the groin and threads it up through blood vessels to the blood clots in the brain causing the stroke.
In roughly the same time it would take someone to drive from Baltimore to D.C., a stroke victim in Bethesda was admitted, tested, diagnosed, and a specialist from Baltimore was able to initiate treatment.
In January 2017, Johns Hopkins Neuroradiologist Dr. Ferdinand Hui was flown from Johns Hopkins Hospital in Baltimore to Suburban Hospital in Bethesda in 19 minutes. The patient was identified at Suburban at 11:12 a.m. Dr. Hui inserted the catheter into the patient at 1:07 p.m.
“So borrowing a page from transplant surgery where they fly a doctor to a site where there's a liver, what we did was fly a doctor, in this case me, to the hospital that has a patient,” said Dr. Hui, the director of interventional stroke for the National Capital Region.
He calls the transport service “helistroke,” and to his knowledge, Hopkins is the first hospital to try this physician-to-patient treatment model.
“If you can imagine, transporting a sick patient, you need the nurses, you need the safety equipment, all the monitors, all that takes time, money, and weight and fuel is expensive. Transporting me, it's just one person, no monitor, no other people,” Hui said.
The service saves money but also precious minutes that could make a critical difference.
“If you can open a blood vessel within 150 minutes of onset, you have a 91 percent chance of having a good outcome,” said Hui.
And he's seen good outcomes before. He's treated patients with debilitating strokes and seen them walk out of the hospital two days later.
“That's what we're trying to do with stroke: walk out of the hospital, versus never work again. Walk out of the hospital versus staying in the hospital for two to three months and then long-term assisted living. So, that's what's at risk with stroke, that's what we're trying to do and saving three hours in transport could be the difference in someone walking out of the hospital and somebody ending up disabled,” said Hui.
Dr. Hui has tried helistroke three times now.
He doesn't see it as a feasible long-term plan for somewhere like Suburban Hospital in Bethesda where he’s currently working with the administration there on providing 24/7 stroke care. However, for rural hospitals it could make sense.
Once Dr. Hui has collected more data, he plans to present the model to insurance companies. By getting a patient treatment faster, they can potentially save money by spending less on a patient over time.
Currently it's the hospital caring for the patient that pays for the physician transport.
And while costs vary among hospitals, transferring a physician was roughly 20 percent less than transferring a patient. The average cost of transferring a physician is around $2,000–$3,000, while the average patient helicopter transfer cost is $6,500–$8,000, according to the press release issued by Johns Hopkins Medicine.
