International Stroke Conference (ISC)
February 17-19, 2016
February 17, 2016
The delicate intricacies of Telestroke networks were fully exposed in this interesting session at the International Stroke Conference. The discussion mainly focused on how to set-up Telestroke networks including organizing hubs and spokes, quality and outcome reporting and economic, legal, licensing and credentialing considerations. The highlights have been summarized below.
This field has grown significantly since it origins back in the 1920s. However, it wasn’t until more recent years that it became mainstream care for acute stroke patients after an inflow of literature proved this technology to be a cost-effective intervention from both a societal and hospital perspective. There are essentially three Telestroke network models. The Hub-Spoke one in which a tertiary center provides the service to satellite primary centers, the distributed model where the expertise is delivered by a third party and patients are transferred to available tertiary centers and the Hub-less model where physicians that belong to different institutions take Telestroke call on a rotatory basis to provide regional coverage. Regardless of the model, hubs and spokes may face multiple challenges while trying to institute this technology including, but not limited to, cost burden for small hospitals, commitment from staff for call coverage, access to outside hospital data, ability to interact with the patients and perform accurate physical examinations and the ability to obtain follow-up information on the cases. Often, quality maintenance may become challenging and time consuming requiring 24/7 availability of clinical and technological support, ongoing staff training, hardware and software technology updates, and imaging-sharing capabilities, among others. One topic that was highlighted by several speakers was the need to implement a signed agreement between parties that clearly delineates the type of service provided whether it is consultation only or if ownership privileges are allowed. Unfortunately, no quality measures have been created specifically for Telestroke purposes but national quality improvement strategies such as Target Stroke and Get-With-The-Guidelines can be used for this purpose. Legal and Licensing issues are most often related to the state where this technology is practiced, most importantly the state where the patient that receive care is. Overall, Telestroke has proven to be a reliable practice with minimal variation in stroke assessments (NIHSS) when compared to standard examination, which reduces door-to-needle times and increases the rate of intravenous t-PA administration and endovascular acute stroke treatment leading to better outcomes.
Telestroke is on its way of becoming a large electronic stroke unit that allows stroke experts and tertiary centers connect to stroke patients who need quality diagnosis and treatment regardless of their location. Patient enrollment to clinical trials is another future potential application of this technology. Watch out for this developing field, much more will come and remember: “Successful Telestroke Networks pay attention to details”.
– Luciana Catanese, MD