Choi John Y, Porche Nichole A, Albright Karen C, Khaja Aslam M, Ho Victor S, Grotta James C
Department of Neurology, University of Texas Health Science Center, Houston, USA.
Jt Comm J Qual Patient Saf. 2006 Apr;32(4):199-205. doi: 10.1016/s1553-7250(06)32025-9.
Recent stroke-care requirements state that all stroke patients should be screened for intravenous recombinant tissue plasminogen activator (rt-PA) and treated, if the appropriate inclusion and exclusion criteria are met. Two community hospitals 90-130 miles east of Houston deployed telemedicine (videoteleconferencing) to provide acute stroke consultative services. DEVELOPING A TELEMEDICINE CAPACITY: According to the Brain Attack Coalition's recommendations, neurosurgical services need to be accessible within two hours. Given their incomplete neurology coverage, the remote-site hospitals identified telemedicine as the best option, with the University of Texas Health Science Center at Houston stroke team as the provider of expertise.
In the 13 months preceding the telemedicine project (January 2003-March 2004), 2 (.8%) of 327 patients received rt-PA, compared with 14 (4.3%) of 328 patients during the telemedicine project (April 2004-May 2005), p < .001). Seven patients had > or = 4 points improvement in a stroke scale at 24 hours posttreatment. Three patients worsened during the 24-hour assessment. No intracerebral hemorrhages occurred. Door-to-needle median time was 85 minutes (range, 27-165 minutes).
Telemedicine facilitated thrombolytic therapy for acute stroke patients and is intended not to replace care provided by remote-site providers but rather to address a time- and spatially related emergency need.
近期的卒中治疗要求指出，所有卒中患者都应接受静脉注射重组组织型纤溶酶原激活剂（rt-PA）筛查，若符合适当的纳入和排除标准则进行治疗。休斯顿以东90 - 130英里的两家社区医院部署了远程医疗（视频电话会议）以提供急性卒中咨询服务。
根据脑卒中介入联盟的建议，神经外科服务需在两小时内可及。鉴于其神经科覆盖不完全，远程医院将远程医疗视为最佳选择，由休斯顿德克萨斯大学健康科学中心的卒中团队提供专业知识。
在远程医疗项目之前的13个月（2003年1月 - 2004年3月），327例患者中有2例（0.8%）接受了rt-PA治疗，而在远程医疗项目期间（2004年4月 - 2005年5月），328例患者中有14例（4.3%）接受了rt-PA治疗，p <.001）。7例患者在治疗后24小时卒中量表评分改善≥4分。3例患者在24小时评估期间病情恶化。未发生脑出血。门到针中位时间为85分钟（范围，27 - 165分钟）。
远程医疗促进了急性卒中患者的溶栓治疗，其目的不是取代远程医疗服务提供者提供的护理，而是满足与时间和空间相关的紧急需求。
