Thrombolysis delivery by a regional telestroke network--experience from the U.K. National Health Service

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.

Keywords: NHS; telestroke; thrombolysis.

Figure 1.

Geographical organization of the East of England telestroke network. As per data from National Health Service (NHS) Information Centre for Health and Social Care, annual overall emergency attendances (case load for all emergency cases, not stroke alone) and hospital bed size for each of the participating sites is shown for 2009–2010, except for Lister Hospital for which these figures were not available and thus 2012–2013 figures have been mentioned.