Abstract W P294: Integration of TeleStroke into an Established Telemedicine System
Background and Purpose: Most acute stroke patients first present to the emergency department. Emergency personnel are often encouraged to maintain a low threshold for stroke activations to capture all potential candidates for early treatment options. However, a national shortage of neurologists has placed a strain on the stroke specialists providing oversight for all these activations. Our stroke team faced a situation in which there were a limited number of neurologists and consistent coverage was not possible to satisfy primary stroke center qualifications. We report on the development of a hybrid system in which neurology oversight was provided by telemedicine consultation for times in which our neurologists were not available.
Methods: Telestroke services were integrated into an established telemedicine system already servicing 17 EDs for general emergency consultations. The system has been in operation for ten years seeing over 425,000 patients with a technical failure rate of 0.00025%. In this protocol, the client ED is considered an extension of the ED of the comprehensive stroke center and activations are simultaneously initiated at both the telemedicine and consultant sites to engage the stroke specialists. After activation, the neurologist is video-conferenced into the telemedicine consultation by way of a personal ipad. Neuroimages are available to the neurologist at the telemedicine consulting site by cloud technology.
Results: This telemedicine system is experienced in remotely assisting in stroke management. There is a first line triage of stroke patients by emergency physicians at a comprehensive stroke center with input from a stroke neurologist. If the case requires a neurointerventionalist then rapid transport to the comprehensive stroke center is facilitated by having routed the consultation through an emergency telemedicine system. By integrating with an established system, the telestroke service was operational within 45 days of the agreement.
Conclusions: By using this innovative hybrid approach which utilizes a combination of both local neurologists and telemedicine consultations we were able to meet the coverage requirements for stroke center certification.
Author Disclosures: K.C. Isom: None. R.L. Summers: Speakers' Bureau; Significant; Genentech, None. K. Henderson: None.
- © 2014 by American Heart Association, Inc.