August 28, 2014

Regional hospitals located in rural areas of southeastern Bavaria and Germany that implemented a TeleStroke project incorporating multidisciplinary teams, continuing education and telemedicine had improved stroke care during a 10-year period, according to results published in Stroke.

Researchers evaluated data from reports and prospective registries from 2003 to 2012. The goal was to determine the impact of the TeleMedical Project for integrative Stroke Care (TEMPiS) on outcomes and processes among patients with stroke and transient ischemic attack at hospitals that incorporated the program since implementation in 2003 to 2005.

TEMPiS is a TeleStroke Unit network developed to improve the implementation of stroke unit care in rural areas throughout southeastern Bavaria and Germany. The network includes two neurological stroke centers and 15 regional hospitals within the region, none of which contained a stroke unit prior to 2003. The stroke units included a multidisciplinary team, standardized care protocols and routine use of IV thrombolysis. All team members receive continuing training from the two incorporated stroke centers. The program also incorporated 24/7 availability of stroke experts via telemedicine, either via telephone contact with a vascular neurologist at a stroke center, transmission of digital brain images or real-time clinical evaluation through videoconference.

“Telemedicine is a wonderful option to support the close cooperation of physicians from regional hospitals and tertiary stroke centers,” Peter Müller-Barna, MD, consultant in the neurology department at Agatharied Hospital, Hausham, Germany, said in a press release. “… Telemedicine can accelerate the emergency transfer of patients in need of neurosurgery. At the same time, it helps avoid unnecessary transfers because expert vascular neurologists are involved in remote patient assessment.”

From February 2003 to December 2012, TEMPiS hospitals treated 54,804 strokes and TIAs, and 31,864 teleconsultations were performed within the network. Implementation of TEMPiS increased the number of patients treated for stroke and TIA at hospitals with TeleStroke units from 19% to 78% (P<.001), according to the results.

In total, 3,331 patients received IV thrombolysis. During the evaluated period, the number of patients who received thrombolysis increased from 2.6% of all patients hospitalized with ischemic stroke to 15.5% (P<.001), while the median onset-to-treatment time decreased from 150 minutes to 120 minutes (P<.001). Door-to-needle times also decreased from 80 minutes to 40 minutes (P<.001); however, median onset-to-door time did not significantly change. Patients also received thrombolysis within 1 hour of admission significantly more frequently in 2012, compared with 2003 (80% vs. 26%; P<.001).

The researchers also noted a decrease in length of hospital stay since implementation of the program, and that quality of care parameters assessing diagnostics, treatment and outcome for stroke showed improvement over time.

“The TeleStroke Unit network TEMPiS is an example of how the challenges of area-wide implementation of stroke units in rural areas can be met,” the researchers wrote. “Although network structures have to be adapted to regional features … we think that many of the experiences gained in the TEMPiS concept might be used as a role model for other rural areas.”

Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.


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