Introduction: Stroke patients should be managed in a stroke unit incorporating a team which includes, at a minimum, nursing, medical, physiotherapy, occupational therapy and speech therapy staff with specialist training in stroke. In remote and rural areas, specialist medical input may not always be available. Western Isles Health Board covers a population of 26,000, with an average of 38 stroke patients per year, with no locally available stroke specialist.
Innovation: A weekly stroke multidisciplinary meeting in the Western Isles Stroke Unit led over a N3 videoconferencing link by a remote Stroke Consultant (0.5 PA per week). This videolink provides the capability for the specialist to ‘meet’ patients and carers, if required, and to remotely review the medical case records and brain imaging. We report a 6-month pilot of this service with monitoring of length of stay and a focus group (including all members of the stroke team and a carer) to assess acceptability.
Evaluation: During the 6-month pilot 20 patients were managed by the telerehabilitation service. Average length of stay fell from 26.5 days in the same period in 2011 to 21.5 days in the evaluation period in 2012. No technical failures occurred. Qualitative data will be presented, but feedback from members of the team and from the carer involved in the focus group was universally positive. The cost of running the service (including twice yearly team visits by the stroke physician) is £5,600 per annum compared with usual care.
Conclusions: This telerehabilitation service is feasible, acceptable and sustainable. Numbers in the pilot were small but it may have a positive impact on the length of hospital stay. It is a model which could be relevant to other remote stroke services and to other speciality areas.