Canterbury and Northland are looking to follow Wellington in offering an after-hours telehealth service proven to increase the number of stroke patients receiving clot-busting interventions.

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” says Wellington Neurologist and pilot lead Dr Anna 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  (DHB) region has now adopted Telestroke permanently and added Whanganui and Masterton hospitals.

The Midland DHB group, led by Waikato DHB, is establishing a similar service with Northland about to roll out its own version.

Christchurch neurologist Dr John Fink says the Canterbury DHB has also submitted a Telestroke business case and received some funding support from the Health Ministry, proposing Christchurch-based neurologists as the expert “hub”, providing support to “spoke” hospitals across the entire South Island.

Andrew Panckhurst from Mobile Health and the NZ Telehealth Forum, says it’s fantastic to see telehealth initiatives like Telestroke turning into everyday business-as-usual health solutions.

How does Telestroke work?

  • Once a patient presents to a regional hospital emergency department after-hours with a suspected stroke, the local ED team puts in a call to have a remote on-call neurologist or stroke specialist notified.
  • A portable wi-fi connected Telestroke unit (provided by Vivid Soutions) is then wheeled to the patient’s bed.
  • The neurologist then uses a 4G iPad to dial into the set-up mobile unit, via the secure national health network, to lead a clinical team evaluation of the patient, who is then sent for a CT brain scan.
  • The neurologist reviews the scan shortly afterwards via a Picture Archiving and Communication System (PACS). If clinically indicated, the neurologist can then immediately order administration of intravenous thrombolysis treatment (Alteplase)
  • After the hour-long infusion, patient care is handed back to the regional physician.

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