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Stroke is currently the fourth leading cause of death and a major cause of disability in the United States. Enhanced Stroke Systems of Care within a Healthcare system is crucial for proper treatment of patients suffering with stroke.

TeleSpecialists recommended paradigm for Value-driven Stroke System of Care includes:

  • Evidence based protocols for prehospital care and triage
  • Identification of an organizational strategy for a “Hub and Spoke” program which allows rapid assessment and treatment at designated spoke sites (Acute Stroke Ready Hospitals or Primary Stroke Centers) and hub sites (usually either Primary Stroke Center or Comprehensive Stroke Center). This will include cooperative strategy with EMS for appropriate transport protocols within this System of Care
  • Joint Commission certification for Primary Stroke Center or Comprehensive Stroke Center certification
  • Protocols for initial assessment of the patient
  • Lean Process Improvement within the infrastructure of the Emergency Department for Quality driven and efficient care with goal Door To Needle Time of 60 minutes more than 90% of encounters
  • Implementation of appropriate neuroimaging protocols for identification of patients needing interventional thrombolectomy
  • Process flow for rapid identification of patients appropriate for intervention

Implementation of protocols for rapid identification of patients with stroke at initial encounter and subsequent rapid activation of the telestroke protocol, and prompt presence of teleneurology expertise at bedside within 10 minutes are key to success of the Systems of Care implementations by TeleSpecialists.

Class I recommendation based on level A evidence supports the use of high quality video conferencing systems for performance of telemedicine consultations for telestroke using the NIH Stroke Scale based examination using help on ground.