On the road to mobile Telestroke – Connectivity should be consideration #1

In the race to treat strokes and mitigate the chance of developing serious long-term disability, time is of the essence.

From the onset of symptoms, a stroke patient only has a three-hour window in which tPA, the clot-busting and lifesaving stroke drug, can be most effective. Once that window closes, the chances of recovery plummet. Unfortunately, many regional and rural hospitals don’t have a 24-hour neurologist on hand to make critical, timely diagnoses. To add to an already dire situation, only about 27 percent of stroke patients arrive at the hospital within three and a half hours of symptom onset, leaving nearly three-quarters of stroke patients at risk for more permanent damage1. In an effort to deliver care to patients in a timelier manner, systems are increasingly looking into mobile telestroke programs.

Mobile telestroke technology connects real-time video telemedicine transmissions from the field to on-call neurologists at stroke centers. Now, instead of meeting a neurologist upon arrival at the hospital, a potential stroke patient’s assessment can begin before they are even in the ambulance. Access to rapid, specialized care in the field has the potential to drastically improve stroke treatment and patient outcomes.

Some programs have created an all-in-one Mobile Stroke Unit in the ambulance with a head CT scanner onboard and a video link to neurologists who can read the scan results and order treatment en route, removing the need to get a scan at the hospital, therefore greatly reducing the time to treatment.

A second, more cost effective approach, is to add the video link (but not the CT scanner), allowing more ambulances to be video-enabled since the Mobile CT is an expensive piece of technology. The video and communications link enables remote neurologists to review cases while en route to the facility. If diagnosed with a stroke, the CT scanner can be readied and the patient can go straight to CT and tPA treatment where appropriate, bypassing the emergency department completely. This option shaves minutes from the time of symptom onset to time of treatment.

Regardless of the approach taken, a mobile telestroke initiative must be able to consistently and reliably deliver a high-quality, telemedicine connection to a physician in real time. Rural areas, with few cell towers and limited access to broadband, often lack dependable, consistent connections. Even urban areas with plentiful cell towers can have dead spots and experience erratic connectivity. Without a robust, unfailing connection, the life-saving benefits delivered via mobile telestroke programs are limited.

When implementing a truly mobile telestroke program, health systems must deploy a combination of software, hardware and services that can successfully facilitate exceptional quality video encounters and unparalleled availability, even in the most difficult environments. To reap the benefits of a mobile telestroke program, ambulances must be able to reliably start and maintain a connection with neurologists while traveling to the hospital – saving time, reducing costs, and ultimately, improving the outcomes of stroke victims.

1.) Tong D, et al. Times from symptom onset to hospital arrival in the Get With The Guidelines-Stroke Program 2002 to 2009: temporal trends and implications. Stroke. 2012;43:1912-1917.

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