Telestroke network's 10-year record shows steady gains

Bringing quality healthcare to remote areas is not only feasible but sustainable. In Germany, a telestroke network launched in 2003 demonstrated progressive improvement over a decade, according to an article published online Aug. 21 in Stroke.

The research team including co-authors Peter Müller-Barna, MD, and Gordian J. Hubert, MD, of Städtisches Klinikum München GmbH, reviewed strides made by telestroke units in improving rural care for patients with stroke and transient ischemic attacks (TIA). The telestroke system used by the Telemedical Project for integrative Stroke Care (TEMPiS) was implemented in rural Bavaria during 2003 and evaluated by the team until 2012. Utilizing data from a number of available stroke registries and one major health insurance database, they were able to create a picture of changes in care over the 10-year span.

Through the use of this telestroke model, Müller-Barna et al found that stroke and TIA patients were admitted to hospitals with dedicated stroke units more frequently, increasing from 19 percent before the network began, to 52 percent in 2003, ultimately increasing to 78 percent of patients in 2012. The mean number of patients with stroke and TIA per hospital per year likewise increased over time, as had the number of teleconsultations.

The use of intravenous thrombolysis increased; in 2003, thrombolysis was used in 63 cases, whereas the treatment was used in 685 cases in 2012. Onset-to-treatment times decreased over the course of the 10-year span by 30 minutes (150 minutes in 2003, 120 minutes in 2012). Door-to-needle times also decreased by approximately 40 minutes.

In 2012, 80 percent of thrombolysis treatments were administered within the first hour following admission, as opposed to only 26 percent in 2003.

Müller-Barna et al wrote that seven-day outcomes and length of stay improved noticeably due to the improvements. Length of stay decreased by up to three days and in-hospital mortality in ischemic stroke patients decreased from 5 percent in 2003 to 3.1 percent in 2012.

They noted a few problems with efficient implementation of care, including healthcare regionalization potentially lengthening the time to receive care for certain patients, although many of these issues were dealt with through restructuring aspects of the care system. The team wrote, however, there was room for future improvements.

“This illustrates the growing acceptance of the TeleStroke Units by emergency services personnel and general physicians, and also by the population and their political representatives. Still, the goal should be closer to 100 percent and we are now setting up further units in administrative districts that lack one,” Müller-Barna said in a press release.

Ultimately, Müller-Barna et al recommended the TEMPiS concept as a role model for improving rural stroke care.