Researchers believed offering Telestroke advice from tertiary hospital experts to regional centres would upskill local clinicians as well as improve out-of-hour access to clot-busting interventions for stroke patients.
A Telestroke pilot based at Wellington Hospital was held in 2016 to help increase after-hours and weekend access to IV thrombolysis (a clot-busting intervention) in provincial hospitals through neurologists at Wellington Hospital offering expert advice via video-conference equipment.
“The feeling was that transient Telestroke might be enough to upskill the local staff,” said neurologist Dr Anna Ranta, who led the Ministry of Health-supported pilot in the Central region.
To test the benefit of upskilling local teams, Telestroke was discontinued at Nelson Hospital. Following discontinuation, the thrombolysis treatment rate dropped by half – basically to pre-Telestroke rates, said Dr Ranta, whose team’s findings were recently published in the New Zealand Medical Journal. She said this illustrated that Telestroke did not result in sufficient local staff upskilling to retain improved treatment rates once remote expert support is withdrawn.
“Transient Telestroke is not sufficient to keep up the thrombolysis treatment rates at a provincial hospital,” said Dr Ranta. Nelson Hospital is currently considering reinstating the telestroke service.
Stroke is the third most common cause of death and most significant cause of complex adult disability. Despite improvements in stroke prevention, the number of strokes in New Zealand is predicted to increase by 40 per cent over the next 10 years. Clot-busting medication can help reverse stroke symptoms if given rapidly to carefully selected patients, but stroke experts are often unavailable, especially out-of-hours at smaller provincial hospitals. Telestroke helps link tertiary hospital experts via video-conferencing to patients in provincial emergency departments when a local expert is unavailable.
The telestroke service was first piloted in the Central region in 2016, with Wellington Hospital-based neurologists providing after-hours stroke advice via a video link to Hawke’s Bay, Palmerston North, Nelson and Wairau hospitals.
The video-conferencing technology allowed the Wellington-based experts to provide decision support to less experienced frontline clinicians in the region on whether to offer a stroke patient the clot-busting treatment thrombolysis.
The Ministry of Health-supported pilot resulted in a dramatic increase in stroke treatment intervention – doubling rates of stroke thrombolysis from eight to sixteen percent, the highest regional stroke intervention rate across New Zealand.
“Everyone saw what a clear difference it made to patients and clinicians bought into it enthusiastically,” said Dr Ranta. During the six-month trial 164 patients were assessed and 51 given the clot-busting drugs within the vital 4.5-hour window following a stroke.
The Capital & Coast District Health Board has now adopted Telestroke permanently and added Whanganui and Masterton hospitals.
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