1. Thrombolysis Delivery by a Regional Telestroke Network—Experience From the UK National Health Service
- Author
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Anthony O'Brien, Declan O'Kane, Eoin O'Brien, Peter Phillips, Paul Guyler, Patrick J. Barry, Paul E. Cotter, Kneale Metcalf, Elizabeth A. Warburton, Lynda Sibson, Diana J. Day, Raj Shekhar, David Collas, Smriti Agarwal, and Peter Owusu-Agyei
- Subjects
Male ,thrombolysis ,Telemedicine ,Time Factors ,medicine.medical_treatment ,Population ,telestroke ,Hemorrhage ,Health Services Accessibility ,Regional Health Planning ,State Medicine ,Time-to-Treatment ,After-Hours Care ,Fibrinolytic Agents ,NHS ,Predictive Value of Tests ,Residence Characteristics ,Humans ,Medicine ,Thrombolytic Therapy ,education ,Stroke ,Original Research ,Aged ,Aged, 80 and over ,education.field_of_study ,Remote Consultation ,business.industry ,Stroke mimics ,Thrombolysis ,Middle Aged ,medicine.disease ,National health service ,Treatment Outcome ,England ,Female ,Rural Health Services ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care ,Fibrinolytic agent - Abstract
Background The majority of established telestroke services are based on “hub‐and‐spoke” models for providing acute clinical assessment and thrombolysis. We report results from the first year of the successful implementation of a locally based telemedicine network, without the need of 1 or more hub hospitals, across a largely rural landscape. Methods and Results Following a successful pilot phase that demonstrated safety and feasibility, the East of England telestroke project was rolled out across 7 regional hospitals, covering an area of 7500 square miles and a population of 5.6 million to enable out‐of‐hours access to thrombolysis. Between November 2010 and November 2011, 142 telemedicine consultations were recorded out‐of‐hours. Seventy‐four (52.11%) cases received thrombolysis. Median ( IQR ) onset‐to‐needle and door‐to‐needle times were 169 (141.5 to 201.5) minutes and 94 (72 to 113.5) minutes, respectively. Symptomatic hemorrhage rate was 7.3% and stroke mimic rate was 10.6%. Conclusions We demonstrate the safety and effectiveness of a horizontal networking approach for stroke telemedicine, which may be applicable to areas where traditional “hub‐and‐spoke” models may not be geographically feasible.
- Published
- 2014
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