Availability of TeleNeurology and TeleNeurosurgery Consultation Could Increase Use of Effective Intervention for Patients With Stroke
On-demand access to both teleNeurologists and teleNeurosurgeons could increase the use of effective intervention (tPA) for patients experiencing an acute ischemic stroke in two ways:
- Providing expert specialty consultation to emergency department teams to appropriately diagnose the stroke and administer the tPA, if indicated.
- Overcoming on-site clinician reluctance to use tPA due to concerns about its safety profile and potential for cerebral bleeding and need to have a neurosurgeon on standby.
Despite proven effectiveness, use of tPA (tissue plasminogen activator) for patients experiencing an acute ischemic stroke is not universal. Fewer than 4 percent of patients with acute ischemic stroke received tPA in 2013; by 2017 the proportion had increased only to between 12 percent and 18 percent, depending on the age of the patient.
Clinical guidelines from the American Heart Association strongly recommend intravenous administration of tPA within 4.5 hours of the onset of symptoms. Patients receiving tPA are almost twice as likely to have a favorable outcome, according to the American Stroke Association.
Reasons for the less-than-universal use of tPA:
Lack of neurology coverage: Not every hospital emergency department has access to a neurologist who can determine the type of stroke – ischemic or hemorrhagic – and who can direct administration of the intravenous tPA. The shortage of neurologists nationwide is well-documented and is particularly acute in rural areas, leaving many communities with no access to emergency neurological response in the event of a stroke.
Access TeleCare’s teleNeurology programs work with hospitals of all sizes to ensure 24/7 neurology coverage through telemedicine. These programs have resulted in a time-to-video consult of 13 minutes and a door-to-needle time as low as 16 minutes.
Clinician concern about tPa safety profile: Even with a neurologist, clinicians may remain reluctant to administer tPA because of the potential risk of bleeding following administration and the need for standby access to a neurosurgeon for surgical intervention. This reluctance persists despite research showing that neurosurgery following administration of tPA is low, according to research published in the Journal of Stroke and Cerebrovascular Diseases.
In hospitals where clinicians do perform tPA, patients are often transferred to other facilities where a neurosurgeon is available, in the event of a cerebral bleed.
Dr. Annie Tsui
Chief of Neurology | Access TeleCare
“Access TeleCare is pioneering the use of teleNeurosurgery consultations, building on its legacy of leadership in telemedicine and its large teleNeurology footprint.
Having on-demand teleNeurosurgery consultations is the next step in building and deploying full-spectrum neurology programs for hospitals of all sizes and improving access to the standard of care for patients experiencing a stroke, no matter where they live.”
Access TeleCare teleNeurosurgery programs can help hospitals both increase the use of tPA in patients with ischemic stroke and reduce transfers of patients with stroke who are then treated with tPA. Having a teleNeurosurgeon who can consult with the patient, neurologist (either in person or remote), and on-site clinicians and attest to the low likelihood of the need for surgical intervention can help on-site teams feel more confident keeping post-tPA patients in-house and not transferring them.
For more information about teleNeurology and teleNeurosurgery with Access TeleCare, visit AccessTeleCare.com/teleNeurology.