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Using Telemedicine to Facilitate Thrombolytic Therapy for Patients with Acute Stroke

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Abstract:

Background: Recent stroke-care requirements state that all stroke patients should be screened for intravenous recombinant tissue plasminogen activator (rt-PA) and treated, if the appropriate inclusion and exclusion criteria are met. Two community hospitals 90–130 miles east of Houston deployed telemedicine (videoteleconferencing) to provide acute stroke consultative services.

Developing a Telemedicine Capacity: According to the Brain Attack Coalition's recommendations, neurosurgical services need to be accessible within two hours. Given their incomplete neurology coverage, the remote-site hospitals identified telemedicine as the best option, with the University of Texas Health Science Center at Houston stroke team as the provider of expertise.

Results: In the 13 months preceding the telemedicine project (January 2003–March 2004), 2 (.8%) of 327 patients received rt-PA, compared with 14 (4.3%) of 328 patients during the telemedicine project (April 2004–May 2005), p < .001). Seven patients had ≥ 4 points improvement in a stroke scale at 24 hours posttreatment. Three patients worsened during the 24-hour assessment. No intracerebral hemorrhages occurred. Door-to-needle median time was 85 minutes (range, 27–165 minutes).

Discussion: Telemedicine facilitated thrombolytic therapy for acute stroke patients and is intended not to replace care provided by remote-site providers but rather to address a time- and spatially related emergency need.

Document Type: Research Article

Publication date: 2006-04-01

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