Stroke victims could get critical speedy care with a 'robodoc', reports Ciara O'Brien
BEING TREATED by a robot in place of a doctor may sound like the stuff of sci-fi films, but it will be a step closer if a proposal by the developing Dublin and mid-Leinster stroke network is approved.
About 10,000 people in Ireland suffer from strokes each year and of that number, 2,500 die - more than 20 per cent. The mortality rate is higher than bowel, breast and prostate cancer combined, and experts hope that the use of the Remote Presence (RP-7) would help reduce that rate by improving access to life-saving treatment.
The RP-7, essentially a "robot doctor", brings telemedicine a step further into Irish hospitals. Made by US firm In Touch Health, it essentially acts as the eyes and ears for the doctor at the scene when they cannot be immediately present.
It is intended for use in accident and emergency departments, where specialists aren't ordinarily present, which can cause difficulties when patients are admitted suffering from a suspected stroke.
The proposal for the cutting-edge technology is part of the move towards improving stroke care for patients in the region. The five hospitals - Tallaght, Mullingar, Naas, Tullamore and Portlaoise - have banded together to develop the stroke network in the belief that co-ordinating their efforts to prevent and treat strokes will ultimately lead to better care.
The network aims to provide comprehensive stroke care for patients, from primary prevention and acute thrombolysis to multidisciplinary rehabilitation and continuing secondary prevention and care after a stroke.
Speed is critical when treating stroke patients. There is a three-hour window in which a clot-busting drug can be administered to suitable patients, which can dramatically improve their prognosis.
"Strokes happen all hours of the night, 24/7, at weekends, bank holidays, and one of the challenges we have is how do we give this treatment and make it available in every accident and emergency department that is receiving stroke patients," says Dr Ronan Collins, geriatrician and stroke specialist at Tallaght Hospital.
"We've only got three hours. We can't bus everyone here, or into the Mater. They won't make it within three hours."
For some, the delay can mean the difference between life and death, while others may suffer more severe disability as a result.
The 2008 audit of national stroke services found that only 1 per cent of patients who are admitted to hospital suffering from stroke get thrombolysis, the treatment to break up abnormal blood clots. Experts are hoping that the use of the RP-7 could speed up access to this potentially life-saving treatment.
Already in use in US hospitals, RP-7 has helped improve the delivery of acute thrombolysis treatments, boosting it from 3-5 per cent of patients to more than 50 per cent of ischaemic stroke patients.
The lack of stroke specialists in hospitals can cause problems - there may only be one in some hospitals, who cannot be available 24 hours a day, seven days a week.
This is where the RP-7 plays a role. "This is one of the potential solutions for providing a specialist opinion in an urgent situation on a 24/7 basis in any hospital in the country," says Collins.
The RP-7 uses high-resolution cameras to enable doctors to examine patients, using a laptop and a broadband connection. Through the remote unit, the specialist can examine any necessary tests or scans, and zoom in on the patient to examine areas of interest that could be vital to the diagnosis.
"The consultant - be it a local consultant, or one up here - can be on call and be almost physically present while the examination is carried out in Mullingar or Tullamore. We'll be able to see the scans on the screen, and we will be able to see the examination of the patient.
"We'll be able to talk to the patient, and the patient will be able to talk to us, or if the patient is unable to, we can talk to their family or next of kin and discuss the diagnosis and treatment options and, more importantly, the risks of the treatment."
The idea of being treated by a robot with a disembodied voice may not appeal to every patient, but acceptability tests run by Johns Hopkins hospital in the US have indicated that not only do patients feel that the care provided by the RP-7 is equal to the care delivered by more traditional doctors, but in some cases, the patients preferred to deal with the doctor via the RP-7 unit.
"That's likely to be a cultural thing," says Collins. "I think in Ireland, people like human contact. We're very much a tactile race in that sense. We like the experience of the person there with us.
"But people talk about a consultant-delivered service and they talk about access to specialist opinion. Realistically, if you want to provide that 24/7 to people in emergency departments around the country, we are going to have to look at systems. What happens currently is that people don't get the access acutely they need to get or they get it too late."
In Touch Health has sold 220 of the RP-7 devices to hospitals around the world. If the Dublin mid-Leinster stroke network decides to invest, it would be the first of its kind in the Republic.
With the recent spending cutbacks announced by the Government, it may be a tall order getting funding for the device, which will cost in the region of €65,000 per year.
However, Collins hopes the value in giving better treatment to patients, yielding a better prognosis, thus eliminating some of the costs associated with rehabilitation and ongoing treatment for stroke patients will be enough to convince health bosses that the RP-7 is worth it.
To get the project off the ground, Collins explains that they have applied for a HSE innovation award to fund the pilot programme. If the hospitals get the funding, the RP-7 with all its accompanying systems can be installed in a matter of a couple of weeks.
Already work has commenced on getting agreement to use the system. "We haven't been waiting for the funding to arrive - we've been laying the groundwork between partners in the hospitals," says Collins.
The device isn't limited for use with stroke patients only. In fact, it can be used where any urgent examination is required including paediatric care, suspected cases of meningitis, vascular and neurological cases.
"I'm not saying this should replace the presence of a doctor physically - it shouldn't," says Collins. "But time is 'brain', and you are losing neurons for every minute you are missing. This is one way that you can deliver the system."