Not every hospital has the capacity to keep a neurologist on call to treat stroke patients. Many regional hospitals only keep one or two doctors on staff; a specialist simply costs too much for many of these facilities that operate on thin margins as it is. Strokes, though, happen everywhere, and hospitals may provide stroke service through remote neurologists. A recent study reveals that this system, called telestroke, improves outcomes in rural hospitals.
One of the adages for stroke is “time lost is brain lost.” That is – faster response is directly related to improved outcomes. Sometimes this means clot-busting intravenous therapy, while sometimes surgical intervention may be necessary. When stroke is suspected, and the hospital has telestroke capacity, stroke protocol imaging is be ordered, and a neurologist – a specialist trained in identifying and treating strokes – promptly becomes available via telephone and/or video chat to the physicians on site. This neurologist (who may be in her office in Utah, for example) will visit with the patient via video conference, confer with the on site physician, and review all of the stroke protocol imaging in order to make treatment recommendations.
While telestroke has become increasingly popular around the country, little has been done to study its efficacy. This study evaluated more than 150,000 stroke patients in regional hospitals with and without telestroke capacity; the researchers concluded is that outcomes were notably better at the latter. Patients with ischemic stroke had a higher incidence of reperfusion therapy and lower thirty-day mortality than at non-telestroke hospitals.
Some 30% of all hospital emergency departments have telestroke capacity; and while rural and low-volume hospitals show the greatest benefits of telestroke, they are the least likely to have the capacity. Some of the barriers may include insufficient investment, inadequate internet access, and local regulations on funding. Meanwhile, stroke remains one of the ten leading causes of death in the United States. Unsurprisingly, the mortality rate is higher in those communities without ready access to stroke neurologists.
