Stroke is the fifth leading cause of death worldwide and the leading cause of adult disability. Early stroke treatment is exceptionally effective at improving or reversing the effects of stroke. But high patient numbers, geography, and limited availability of specialized stroke experts present significant barriers to implementing speedy treatment.
Telestroke programs bring swift treatment to patients with stroke in rural or remote settings where doctors with advanced training in treating strokes are usually unavailable. Telestroke services enable more patients to be treated faster, utilize scarce resources more effectively, and improve patient outcomes.
What Are Telestroke Programs?
Technology for stroke patients uses computer systems and audiovisual equipment connected by high-speed internet. A remote stroke neurologist can advise local practitioners via video conferencing about treating patients displaying symptoms of cerebrovascular neurological emergencies.
You can set up a telestroke program using a hub-and-spoke model or as a distributed network. The hub’s nucleus is usually a comprehensive tertiary care center with acute stroke specialists, including vascular neurologists, providing telestroke services to partner sites — small hospitals, mobile stroke units, ICUs, EDs (emergency departments), and medical-surgical units. A distributed telestroke network can link multiple providers with multiple originating sites.
Because time is essential in treating stroke, telestroke equipment should be in place and mobile to treat emergencies when and where they arise. Having everyone trained and able to move quickly makes telestroke programs highly effective, aiding positive patient outcomes.
Why Telestroke Programs Are Effective at Improving Clinical Outcomes
Telestroke programs get proper treatment to stroke patients in time to significantly impact short and long-term outcomes, improving survival rates while reducing disabilities and recurrences.
Local practitioners can better utilize stroke treatment to inhibit platelet formation, dissolve blood clots, or perform endovascular thrombectomy and hemicraniectomy when needed — all with the remote assistance of a highly-trained stroke specialist.
Ischemic strokes account for 87% of all acute strokes. Brain cells begin to die within minutes of the blood supply being cut off, usually by a blood clot blocking blood flow because of plaque buildup in arteries. Speedy administration of the thrombolytic agent alteplase via IV can dissolve blood clots and restore the normal flow of oxygen to dying brain cells.
The guideline-recommended time window for administering alteplase is within 4.5 hours of the first symptoms appearing, with the first hour being called the “golden hour.” Treatment within the golden hour generates the best patient outcomes, so every minute counts. Patients receiving alteplase within the first minutes are almost three times more likely to exhibit minimal or no effects than patients not receiving it.
For stroke patients needing hemicraniectomy, each 30-minute delay reduces the likelihood of an excellent clinical outcome by approximately 15%. These minutes add up quickly if patients must be transported from a rural hospital to a tertiary care facility.
Patients in Rural Hospitals Can Get Time-Sensitive Acute Stroke Care
Rural hospitals are institutions with fewer than 100 beds that are further than 30 minutes travel time from an urban center. Most have less than 25 beds.
A 2020 study on rural/urban inequities in acute stroke management found that rural patients were less likely to be treated with intravenous thrombolysis or endovascular therapy. They also had 30% higher in-hospital mortality rates. Increasing rurality brought a corresponding decrease in favorable patient outcomes.
There are three significant barriers to improving rural stroke care:
- Lack of qualified personnel: Only 8% of new doctors choose to work in a rural setting, and turnover is high among those who do, making physicians few and far between.
- Geography: Distances are vast in much of rural America, translating into long periods from stroke onset to treatment for stroke patients. The same time/geographical issues confront transfers from rural hospitals to tertiary facilities.
- Budget constraints: 41% of rural hospitals have a negative operating margin. Budget and personnel aren’t available to fund and staff a modern, high-tech stroke unit.
Telestroke programs utilizing modern technology for stroke patients can alleviate all three issues by making better use of scarce resources to improve patient outcomes. Discover how the VA is using telestroke to save lives.
Remote Stroke Neurologists Have Easy Access to Imaging
A professionally read CT scan is critical for proper stroke diagnosis to determine the best course of treatment. However, stroke neurologists are usually in urban centers.
Using remote technology, stroke specialists can read local CT scanners to advise onsite personnel in consultations. Rural stroke patients may then be able to receive thrombolytic therapy for ischemic stroke within the 4.5-hour time frame that brings the best results or receive another outcome-altering procedure if diagnosis so indicates.
Unnecessary Transfers Between Hospitals Are Reduced
With more accurate information and qualified stroke specialists consulting in real-time, medical staff can make wiser decisions regarding expensive, time-consuming transfers to urban care centers. Patients receive better care faster while expenses are reduced.
Tissue Plasminogen Activator (tPA) Is Administered at Faster Rates
Proper diagnosis is essential in determining when to use tPA (alteplase) because of the many health conditions that can make its use dangerous. Having protocols in place to quickly identify these conditions and trained stroke specialists available via interactive video makes rapid identification manageable for local practitioners to determine which patients can benefit from receiving tPA.
Leveraging Telestroke Technology
Telestroke programs are developing rapidly as synergistic technologies emerge and are applied. These go beyond using broadband internet to provide consultations to using innovation to reduce specialists’ workloads and alleviate the symptoms of burnout and depression reported by 60% of neurologists.
AI (artificial intelligence) and machine learning can revolutionize telestroke care, bringing faster and more reliable diagnosis using image analysis and predicting prognosis.
Speech recognition software is reliable and convenient. Intelligent electronic medical records can search and analyze patient charts. Automated data collection and analysis can improve program quality and speed up research.
Leveraging synergistic telestroke technologies can enhance the clinician experience enabling scarce resources to treat more patients at lower costs while reducing burnout.
Thoroughly Research and Source a Telestroke Program
Researching telestroke programs will give you the information needed to create a successful model for your needs, operating from a hub or a spoke perspective.
The American Telemedicine Association has published excellent telestroke guidelines covering many aspects of creating telestroke programs, including:
- Building a network of computers and audiovisual equipment
- Delivering telestroke clinical services
- Required personnel
- Economic considerations
You’ll also find recommendations for providing telestroke program training.
Provide Telestroke Training to Healthcare Professionals
Building a successful telestroke program requires training remote hub and onsite spoke personnel in stroke expertise. Clinicians will need education regarding protocols to ensure optimal software and equipment use. Ongoing training may be required for software or technology upgrades and new personnel.
Training should build trust and acceptance of telemedicine while creating team workflows incorporating remote experts and onsite staff. Special training may be required.
Invest in High-Quality Telestroke Carts
Because time is so critical in getting the correct treatment to stroke patients, care facilities need to have telestroke computers and audiovisual equipment set up on a mobile platform that can move quickly to the point of care.
Let’s explore the possibilities together.
Tryten is ready and willing to help with your project, big or small, and our wide variety of platforms can support your medical & technology devices, telehealth expansion, or overhauls and more. Let us use our guidance to support you today.
Investing in a high-quality, purpose-built, mobile telestroke cart will speed diagnosis and treatment, resulting in improved short and long-term patient outcomes while generating savings by using remote experts instead of paying in-house specialists.
The best telestroke cart should incorporate these features:
- A tall pole allows height adjustment for the monitor and microphone to position them above room clutter but in the optimal viewing position.
- Secure support for notebooks, tablets, and Vesa monitors up to 32”.
- Modular design to allow custom setups.
- Medical-grade, wipeable components that make frequent cleaning easy.
- A stable, tip-resistance base tested to IEC 60601 standards mounted on quiet wheels that can handle any surface, including carpets.
Investing in a robust, mobile telestroke cart guaranteed to last for years while bringing critical benefits to patients and staff is wise.
Every Second Matters in a Stroke, and So Does the Cart You Use
Having a professionally designed, special-purpose telestroke cart is an astute investment benefitting healthcare providers and patients. Having all your telestroke communications equipment on a mobile solution and ready to move to the point of care in seconds saves lives and brain cells while reducing disabilities. The Tryten X1 telestroke cart:
- Supports fast diagnosis and treatment, bringing better patient outcomes.
- Has a large carrying capacity designed to hold tablets, notebooks, or Vesa monitors up to 32”. The total cart capacity is 35 pounds.
- It is easy to maneuver quietly using one hand on the integrated handle that allows cord wrapping.
- Provides secure operation with a large utility box containing multiple power points for safely operating devices. A concealed cable management channel keeps cords tucked away.
- Utilizes a small footprint and sleek form to reduce clutter bringing more open space to surgical rooms and patient areas.
- Enables easy setup and cleaning in minutes. Medical-grade surfaces and hidden power cords make frequently wiping down all components a breeze.
The Tryten Telestroke Cart's well-thought-out design results from many years of experience creating custom medical device carts for surgical centers and manufacturers like Butterfly and Philips Sonicare.