Definition of stroke telemedicine (telestroke)
In stroke telemedicine, also called telestroke, doctors who have advanced training in the nervous system (neurologists) remotely evaluate people who’ve had acute strokes and make diagnoses and treatment recommendations to emergency medicine doctors at other sites. Doctors communicate using digital video cameras, Internet telecommunications, robotic telepresence, smartphones and other technology.
Having a prompt neurological evaluation increases the possibility that you may receive clot-dissolving therapies (thrombolytics) or other clot-retrieving procedures in time to reduce disability and death resulting from stroke.
In stroke telemedicine (telestroke) your doctor and the neurologist trained in blood vessel conditions (vascular neurologist) provide care in your home community and try to avoid the need for transfer to another medical center. This focus on regional care often allows you to receive quality stroke care in your community.
Stroke telemedicine operates on a hub-and-spoke system. A large urban medical center, generally certified as a primary or comprehensive stroke center, usually serves as the primary medical center (the hub). Remote locations, usually smaller regional rural or underserved hospitals, serve as the spokes. Many regional hospitals don’t have neurologists on call to recommend the most appropriate care. In stroke telemedicine, a vascular neurologist at the hub consults with doctors and people who’ve had acute strokes at the remote sites (spokes).
In telestroke, many people work together as a team, including a program manager, a clinical coordinator, vascular neurologists, neurosurgeons and radiologists at the hub site, and emergency medicine doctors and other staff at the spoke site. Radiology technicians, informational technology staff, researchers, nurses, nurse practitioners and other staff also are important members of the stroke telemedicine team.
Stroke telemedicine consultation
In a stroke telemedicine consultation, an emergency medicine doctor at your regional hospital (the spoke) will examine you. If your doctor suspects an acute stroke, he or she will activate the stroke telemedicine hotline at the hub hospital, which has a dedicated hotline and group paging system and vascular neurologists on call 24 hours a day, 365 days a year. The hub’s on-call vascular neurologist usually responds within five minutes.
After you have a CT scan at the spoke hospital, the vascular neurologist at the hub performs a live, real-time audiovisual consultation. The vascular neurologist may discuss your medical history and review your test results. The vascular neurologist evaluates you, works with your doctor to determine the most appropriate treatment and sends the treatment recommendation electronically to the spoke hospital.
Having a prompt evaluation increases the possibility that clot-dissolving therapies (thrombolytics) can be delivered in time to reduce stroke-related disability. To be effective, clot-dissolving therapies must be given within three to four and a half hours after you experience stroke symptoms.