20PATTERNS OF ACTIVITY AND RELIABILITY OF AN ACUTE STROKE TELEMEDICINE SERVICE: DUBLIN MIDLEINSTER STROKE NETWORK PARTNERSHIP

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Abstract

Introduction: Telemedicine is increasingly used as an option for acute ischaemic stroke treatment by facilitating immediate stroke-expert consultation particularly out of hours. The Dublin MidLeinster (DML) Stroke Network Partnership initiated a new telemedicine service (RP-7 InTouch Health) in 2009 with the aim of improving the delivery of acute stroke thrombolysis.

Methods: Data were prospectively collected by online consultation entry (Stroke Respond—InTouch Health) for consecutive patients who were assessed for acute thrombolysis using the telemedicine system over a period of almost 3 years, across three acute hospitals. Data regarding FAST notification, reliability of system, acceptability to patient/carer were also prospectively recorded online by post-consultation proforma.

Results: Over the period, 157 patients were fully assessed for acute thrombolysis by telemedicine using the RP-7 system. Average age 65.94 (range 19–91) with a female: male ratio of 1:1. Average time between symptoms onset and presentation to emergency department (ED) was 107 min (0–515 min). Majority (90.4%) of patients presented to ED out of normal working hours (including weekends) (n = 141). Eighty-five patients (54.5%) presented on weekdays (Monday to Friday): only 15 presented during working hours (9 a.m. to 5 p.m.); 49.7% of all patients assessed were thrombolysed (n = 78). Main reasons for not thrombolysing were minor deficits (34.3%), non-stroke diagnosis (15.7%), outside thrombolysis window (11.4%).

Post-consultation proforma was completed in 107 cases. Successful log-in was achieved in all cases bar one (99.1%). 5.6% of physicians reported some difficulty logging in and 22.4% reported some loss of signal during the consultation.

Of the total, 100% patients or carers agreed that the telemedicine was an acceptable form of consultation and all bar one reported that the consulting physician was easily understood and seen on the RP-7 system.

Conclusion: The DML Telemedicine assessment of acute stroke patients was associated with high rates of a positive thrombolysis decision. The RP-7 system (InTouch Health) was very reliable regarding log-in. All the patients and carers found the system acceptable and clear.

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