Abstract 2304: The Use of Teleneurology Consult for Stroke Care in a Rural Community Hospital
Background and Issues Management of acute strokes in our rural facility involved the attending physician telephoning for consultation with a neurologist to determine treatment and/or transfer options since we did not have 24/7 neurology coverage. Based on chart review over a period of 6 months, the turn-around time from ED physician call to neurologist returning the call was approximately 22 minutes. However, the neurologist must make a recommendation based on the relation of the ED physician information without visualization of the patient. Prior to the implementation of the teleneurology program our data collection spanned from April 1, 2009-September 30, 2009. There were 60 patients who had a diagnosis of stroke presenting to our ED. Of those 60 patients: 2 hemorrhagic, 38 ischemic and 30 TIA. Of those 60 patients, 20 had neurology consult, 40 did not, and 3 of the 60 received tPA. 6 had a NIH scale documented and 10 had a Glasgow Coma Scale documented (5 of 10 also had the NIH scale).
Purpose The telemedicine program at our facility was initiated to offer all patients presenting to the ED with stroke symptoms to timely and effective treatment. The technology would allow the neurologist to view the patient information, CT reports, speak to and visualize the patient, formalizing the consult and treatment responsibility for the patient in a very short amount of time.
Methods Our facility uses the telemedicine program Specialist on Call (SOC). Patients presenting with stroke-like symptoms are all candidates for use of teleneurology consultation. The ED physician consults the SOC neurologist with a guaranteed call back time of 15 minutes. After consult, the neurologist makes recommendation to the ED physician. The patient is either admitted to our facility or transferred to our sister hospital where the Stroke Center is located. The SOC neurologist would also determine tPA administration.
Results Since implementation of the teleneurology program May 16, 2011 there have been 25 patients diagnosed with stroke, 14 were SOC cases, none recommended to receive tPA. ED physician call to specialist consult time has decreased to 15 minutes or less. We have also seen a decrease in transfers.
Conclusions Implementation of the teleneurology program at our rural hospital as provided our community access to 24/7 neurological consultation. Patients/families that have been involved with the SOC program expressed great satisfaction the program.
- © 2012 by American Heart Association, Inc.