- Telestroke is finally getting its own guidance document.
The American Heart Association and American Stroke Association have released a scientific statement on quality measures and outcomes for the use of telemedicine in stroke cases, marking the first time that standards have been proposed for this field.
"Telestroke has evolved over the last decade and is now used quite extensively to take care of acute stroke patients in the U.S. and the rest of the world," Lawrence R. Wechsler, MD, chairman of the AHA/ASA writing committee, told Medscape. "Because of this we felt it was time to bring out this statement, which provides a structure against which hospitals can measure the quality of their telestroke programs so patients can be assured of getting the quality they deserve."
“These are suggestions from a group of experts that will help anyone involved in a telestroke program to run the best service possible,” Wechsler added.
Standards laid out in the new AHA/ASA document include:
- process measures, including time to consultation and time to treatment;
- information on where patients are transferred to and why;
- outcomes such as mortality, clinical status, hemorrhage rates and patient satisfaction; and
- quality of communication.
The document, published in the November 3 edition of the online publication Stroke, has been endorsed by the American Academy of Neurology as well as the American Telemedicine Association.
Telestroke care is one of the older and more established telemedicine platforms not only in the U.S., but around the world, driven by a shortage of neurologists and hospitals capable of treating stroke patients. One recent study estimates that three of every four American counties lacks a hospital with neurological services capable of treating stroke.
The most common model involves a hub-and-stroke network, where a large health system with a designated stroke center provides stroke diagnosis and care services via telemedicine to a network of smaller hospitals and remote clinics.
This past July, Kaiser Permanente released the results of a study, involving more than 2,500 patients diagnosed with acute ischemic stroke, that shows an almost 75 percent increase in timely use of the clot-dissolving drug tPA following a telehealth consult with a specialist. In addition, patients receiving a telehealth consult were given a diagnostic imaging test 12 minutes sooner, and the drug was administered 11 minutes sooner – reducing the door-to-needle time to less than an hour.
“These findings have important implications for future delivery of stroke care,” the study concluded. “Particularly in hospitals with limited local resources and/or limited access to neurologic expertise, telestroke is an important tool to aid in the evaluation and treatment of potential stroke. We specifically found that unwarranted hospital variability in stroke care could be eliminated through a standardized telestroke program. Additionally, telestroke may aid in triage and transfer decisions and in identifying patients potentially eligible for endovascular intervention or patients who might otherwise benefit from transfer to a stroke center.”
More recently, health systems have been experimenting with mobile devices and platforms, offering more immediate stroke diagnosis services with EMS services.
"Some of these systems have CT scans in the ambulance and can give tPA right there and then,” Wechsler told Medscape. “Others just use an iPad in the ambulance to connect to the stroke expert — although you can't make a certain diagnosis this way, you can make an educated guess just by assessing the severity of the deficit on the NIHSS [National Institutes of Health Stroke Scale], and this allows advice to be given on the best center for the patient to be taken to. … This whole field is evolving very fast."
Recently, a year-long study conducted by the Atlantic Health System’s Overlook Medical center in New Jersey found that in-transit telestroke services – in this case a paramedic consulting with a specialist via video on a tablet - could shave 15 minutes off door-to-needle time.
“Every minute you can carve off … improves the statistical outcomes,” says John Halperin, MD, chairman of Overlook’s department of neurosciences and lead researcher on the study. “And every minute saved is brain saved.”