Silva GS et al, Stroke, 2012
BACKGROUND AND PURPOSE:
Little is known about adoption or success of telestroke networks outside of published or federally funded programs. Under contract to the Health Resource Services Administration, we conducted an environmental scan of telestroke programs in the United States.
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Müller-Barna P et al, Current Opinion in Neurology, 25(1)
PURPOSE OF REVIEW
This review provides a comprehensive overview of the management of acute stroke within the framework of telestroke services.
RECENT FINDINGS
The remote neurological examination using high quality videoconferencing coupled with remote review of neuroimaging has gained acceptance and proved its reliability in various publications. Telestroke networks confirmed the safety and efficiency of telethrombolysis, with an increase in the rate of thrombolysis in recent years. The analysis of a telestroke network in Europe showed improved outcomes in a cohort of ischemic stroke patients.
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Nelson RE et al, Neurology, 2011
Objective:
To conduct a cost-effectiveness analysis of telestroke—a 2-way, audiovisual technology that links stroke specialists to remote emergency department physicians and their stroke patients—compared to usual care (i.e., remote emergency departments without telestroke consultation or stroke experts).
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Cleland JGF, Barrett D. European Cardiology, 6(3)
Over recent years, telehealth has increasingly demonstrated its value in supporting the delivery of cardiovascular healthcare. From teletriage services as a portal into healthcare through to telemonitoring of heart failure patients, technology is already increasing the ability of practitioners to provide care remotely, empower patients and improve clinical outcomes. In the future, telehealth services have the potential to have an even greater impact on the provision of cardiovascular care.
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Rubin AD, McFerran VA. The American Journal of Managed Care, 16(12 Suppl HIT)
The University of California, Los Angeles (UCLA) Health System seeks to align its purpose of “healing humankind” with its approaches for people and performance management. These approaches include lean process improvements initiatives, sustained by efforts to impact daily team member work flows. The electronic health record (EHR) serves as a powerful supportive instrument in improving processes and sustaining performance.
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Demaerschalk BM. Current Neurology and Neuroscience Reports, 11(1)
The advantages of telephone consultations for patients with acute stroke syndromes are history of use, simplicity, availability, portability, short consultation time, and facile implementation. The favorable aspects of telemedicine consultations are high accuracy, reliability, efficacy, and effectiveness, the growing technological sophistication of the offerings and features, and the high grade of recommendation. Between the two modalities, telemedicine is optimal for assessing patients with acute stroke and superior to telephone-only evaluations.
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Meyer BC et al, Journal of Stroke and Cerebrovascular Diseases, 2010
Telemedicine can provide stroke evaluations in locations with limited available expertise. The reliability of telestroke has been established. Decision making efficacy has been shown in the National Institutes of Health’s STRokE DOC trial. No prospective trial has assessed long-term telestroke outcomes, however. In an institutional review board-approved trial (NCT00936455), we contacted patients originally enrolled in the STRokE DOC trial. A telephone script was used to verify consent. Patients were asked standardized questions regarding disposition, modified Rankin Scale (mRS) score, mortality, and recurrent stroke for 2 retrospective time points (6 and 12 months postevent) and one current time point. Blind was maintained. Primary outcome measures of mortality and percent mRS score of 0-1 [%mRS(0-1)] at 6 months are reported. Wilcoxon’s rank-sum test was used for continuous variables, and Fisher’s exact was used for categorical variables. Of the original 222 participants, 75 patients or surrogates could be contacted. Mean time from enrollment was 3.96 ± 1.0 years (range, 2.33-5.45 years). Mean National Institutes of Health Stroke Scale (NIHSS) score was 8 ± 7 (5 ± 8 for telephone; 12 ± 8 for telemedicine; P = .002).
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Johansson T, Wild C., International Journal of Technology Assessment in Health Care, 26(2)
Objectives:
Stroke is the third largest cause of death and a major factor in permanent disability. Disparities in access to healthcare services exist due to geographical barriers and limited resources. Rural locations often lack the resources for adequate acute stroke care. Telestroke is intended to enable the transfer of knowledge of acute stroke management to areas with limited neurological services. The objective of this study is to assess the feasibility, acceptability, and treatment delivery reliability of telemedicine systems in acute stroke management.
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Moskowitz, Ari et al, Stroke, 2010
Background and Purpose
Telestroke has been effective in the management of acute ischemic stroke. This study characterizes and compares stroke specialist (SS) and emergency physician (EP) perceptions of telestroke and identifies barriers preventing increased implementation.
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Switzer, Jeffrey A. et al, Stroke, 2010
Background and Purpose
Acute stroke clinical trials are conducted primarily at academic medical centers. As a result, patients living in rural areas are excluded from participation, results may not be generalizable to nonacademic settings, and studies may be slow to recruit subjects. Telemedicine can provide rural patients with emergency neurovascular consultation. We sought to determine whether telemedicine facilitates enrollment into acute stroke trials.
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Stradling, Dana A., Critical Care Nursing Clinics of North America, 21(4)
Telemedicine or telehealth has been broadly defined as the use of telecommunications technologies to provide medical information and services. The use of telemedicine in the treatment of stroke-telestroke-has shown great promise in improving patient access to recommended stroke treatments in rural and other underserved areas.
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Pedragosa, Angels et al, J Telemed Telecare, 15(5)
In January 2007, a telestroke system was established between a community hospital lacking a neurologist on call and a stroke centre 70 km away. The telestroke system allowed urgent remote evaluation of the patient by a specialized neurologist, supervised thrombolytic treatment or a decision for urgent transfer to the stroke centre. During the first year of operation of the telestroke system, we studied all acute ischaemic stroke patients admitted to the community hospital and compared the results with the previous year. Approximately the same number of acute stroke patients were admitted to the community hospital in each year (201 cases in 2006 and 198 in 2007).
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Singh, Rajinder, Telemedicine and e-Health, 15(6)
Medical emergencies form a significant proportion of neurological and neurosurgical practice. The highly specialized nature of neurology and neurosurgery limits expertise to a small number of highly specialized centers; hence, many neurological emergencies will be managed in regional hospitals without comprehensive support. The common theme in neurological emergencies lies with prompt diagnosis, rapid access to scans, accurate scan interpretation, and quick institution of appropriate treatment. Failure in any one of these can result in devastating and permanent neurological deficits or death. The judicious use of information and communication technology can overcome some of the limitations imposed by scarce resources.
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Demaerschalk BM et al, Mayo Clinic Proceedings, 84(1)
Stroke telemedicine is a consultative modality that facilitates care of patients with acute stroke at underserviced hospitals by specialists at stroke centers. The design and implementation of a hub-and-spoke telestroke network are complex.
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