Telestroke program improves stroke take care of rural patients

Minutes matter when a patient can have had a stroke, but being removed from a physician with advanced training in neurology not must be a barrier to rapid diagnosis and intervention.

Telestroke programs are designed to enhance access to the limited variety of specialists, whatever the geographic isolation of patients who can have experienced a stroke. Telestroke, or stroke telemedicine, is a type of telehealth by which physicians with advanced training in stroke care use technology to supply immediate consultation to an area healthcare skilled to recommend diagnostic imaging and treatment for patients with stroke at an originating site. Patients who present inside 4.5 hours of after they were last known to be well could also be eligible for thrombolytic drug therapy or endovascular intervention, often measured as door-to-needle time.

After launching a telestroke consultation program, Essentia Health, an integrated health system serving patients in Minnesota, Wisconsin and North Dakota, increased the share of patients receiving thrombolytics in lower than 60 minutes and decreased the common door-to-needle time.

“Use of Telestroke to Improve Access to Look after Rural Patients With Stroke Symptoms” describes how Essentia Health’s program ensures that patients are evaluated rapidly to expedite decisions about their course of treatment. The article is published within the October issue of Critical Care Nurse (CCN).

Essentia Health initiated the telestroke program in fall 2019, with coverage provided by a team of 4 interventional neurologists, three of whom work within the system’s Comprehensive Stroke Center in Fargo, North Dakota. Along with this center, telestroke services are provided to 5 other acute stroke-ready hospitals throughout rural areas within the upper Midwest.

Through the telestroke program, neurology consultations can be found to all the sites 24 hours a day, each day of the yr, and will be used for each inpatient and emergency department stroke activations at each of the facilities.

The team developed a tiered stroke alert algorithm and telestroke workflow chart to assist healthcare professionals at rural sites determine eligibility for telestroke consultation to make your mind up the treatment plan.

The algorithm categorized strokes as level I to III in accordance with the symptoms and time when the patient was last known to be well. Telestroke consults were most frequently used for patients with level I stroke alerts since they were inside the timeframe when they could be eligible for thrombolytic drug therapy or endovascular intervention.

Once staff members determine whether a telestroke consultation might be initiated, they discuss with the step-by-step workflow chart, which specifies actions needed for every member of the multidisciplinary team.

Co-author Chelsey Kuznia, BSN, RN, SCRN, is the stroke program manager for Essentia Health’s Comprehensive Stroke Center in Fargo, one in every of only two such facilities in North Dakota.

Whatever the sort of stroke, rapid diagnosis and intervention are critical for improving survival rates and reducing the long-term effects of stroke. People living in rural areas not only have increased stroke risk aspects, but additionally they face challenges to getting the advanced care they need in a timely way, which results in higher rates of disability and death.”

Chelsey Kuznia, BSN, RN, SCRN, stroke program manager for Essentia Health’s Comprehensive Stroke Center

In 2022, telestroke connections for 42 patients were accomplished, with a stroke diagnosis confirmed in 25 of them (61%). Fourteen of the patients with confirmed stroke received thrombolytic therapy while others weren’t eligible, either due to patient-related contraindications or because greater than 4.5 hours had elapsed since their last-known well time.

Of the 25 patients with confirmed stroke, 18 (72%) were discharged home, while three were discharged to expert nursing facilities, one to an inpatient rehabilitation unit, one to hospice and two died.

The yr prior to implementation of the telestroke program, 11 of 15 eligible patients (73%) received thrombolytic therapy in lower than 60 minutes, with a mean door-to-needle time of 61 minutes. Through the yr after implementation, the outcomes improved: 11 of 12 eligible patients (92%) received thrombolytic therapy in lower than 60 minutes, and the mean door-to-needle time decreased to 38 minutes.

Because the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for acute and demanding care nurses, CCN is a trusted source of data related to the bedside care of critically and acutely in poor health patients.