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A year of firsts at Pagosa Springs Medical Center

The year 2011 was a year of firsts for the Pagosa Springs Medical Center (PSMC).

It became the first medical center in the region to have a 128-slice CT scanner. PSMC hired its first surgeon, Dr. Dave Schaeffer, and its second, Schaeffer’s wife, Dr. Amber Reiss-Holt. Schaeffer performed the first surgery in Pagosa Springs. PSMC had a total net patient revenue over $1 million for the first time.

Thus far, it looks like 2012 will follow the trend of firsts. For the first time, telemedicine was successfully utilized to evaluate a potential stroke victim.

As previously reported in The SUN, in December PSMC signed a contract with Swedish Medical Center in Denver for service and equipment as part of the Collaborative Digital Online Consultant (CO-DOC) program. CO-DOC connects rural hospitals with stroke neurologists at Swedish’s Stroke Center to provide quality, specialty care through a site-independent, Internet-based telemedicine system.

Rosie, the affectionate name the PSMC gave the robot-like telemedicine equipment, is a portable telemedicine device equipped with two cameras, a screen, stethoscope, phone and wheels. If a patient comes to PSMC with stroke symptoms, Rosie is used to allow stroke specialists to remotely evaluate the patient.

Kathee Douglas, director of the ER, explained that the patient who came in three weeks ago was having trouble speaking as well as moving — definite symptoms of a stroke.

After the patient arrived at the PSMC hospital, Rosie was wheeled to the bedside and the CO-DOC number dialed. “Hello, we have a patient with stroke symptoms,” a nurse said to the technician on the other end of the phone.

“In less than five minutes, a neurologist will be on the screen,” Douglas said.

A reverberating cymbal sound is heard coming from Rosie’s speakers. Douglas describes it as similar to the sound on Star Trek when Scotty beams someone up.

“The neurologist beams in just like in Star Trek,” Douglas said.

In this case, it was Judd Jensen, M.D., who appeared on the screen. Once on the screen, Jensen had control of Rosie. He had the ability to zoom the cameras in and out, to show a variety of pictures and evaluate the patient’s responses to questions concerning the pictures. With the help of the Pagosa physician and nurse on duty, Jensen was even able to listen to the patient’s heartbeat. Jensen was also able to access the patient’s file, review the CT scan and consult with other physicians, all within minutes.

“After awhile, the patient doesn’t notice the robot anymore,” Douglas said, explaining that, since the physician on the other end has control, the robot takes on humanlike qualities. During the course of the evaluation, the patient, Douglas said, communicates and feels a connection with the physician.

The tests are being conducted for two reasons: to find out whether or not the patient is experiencing a stroke and, if so, whether the stroke is ischemic or hemorrhagic. If it is ischemic, the patient will be given tPA, a drug that will dissolve the blood clot. In this case, the patient would be able to remain in Pagosa. If the patient were experiencing a hermorrhagic stroke, the patient would have to be flown to a hospital specializing in stroke treatment, such as Swedish Medical Center.

The first patient, Douglas said, could not pass any of Jensen’s tests. However, after approximately 15 minutes, the symptoms began to clear.

“The patient’s symptoms cleared up on their own,” Douglas said, adding, “The patient did not get the clot-busting drug because it was not required.” However, just because a drug was not required and the patient was not having a stroke, does not mean that Rosie was not of use. The symptoms were that of stroke.

“Without Rosie, the patient would have been sent off, and not to Durango. Probably to Swedish,” Douglas said. To be flown to Swedish is an expensive trip, costing upwards of $20,000.

Instead, what happened was Jensen discussed what might have caused the symptoms with a consulting physician at PSMC. Together, they planned a course of treatment and testing.

“Telemedicine affords Pagosa a luxury we otherwise wouldn’t have,” Douglas said.

According to Nicole Williams, Swedish Medical Center’s Assistant Vice President of Marketing, the HealthONE Telemedicince Network in Colorado is growing and expanding into more fields. “We are currently piloting Telemedicine in the Pediatric Intensive Care Unit with one of our doctors from the Rocky Mountain Hospital for Children,” Williams wrote in an e-mail, adding, “We are also currently piloting Telemedicine with Behavioral Health ... We know that there is a great need among our 25 rural hospital partners for that service and are working diligently to develop it.”

Williams also said that, further down the road, HealthONE will be looking into cardiology and other services that are in short supply in the rural regional areas.

Douglas said that PSMC would be looking into expanding the telemedicine service into these other areas once their pilot programs are successfully completed. Until then, Rosie will continue to serve as a means for potential stroke patients in the Pagosa area to be evaluated by specialists, saving trips to larger hospitals and possibly, one day, even saving lives.

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