Department of Medicine, Queensland Health, Logan Hospital, Brisbane, Australia.
Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
J Stroke Cerebrovasc Dis. 2022 Jan;31(1):106171. doi: 10.1016/j.jstrokecerebrovasdis.2021.106171. Epub 2021 Oct 28.
The application of telestroke has matured considerably since its inception in 1999. The use of telestroke is now recommended in several published guidelines. Consequently, jurisdictions without a telestroke service are seeking practical information on the best approach to implement telestroke. French et al. (2013) reviewed the challenges of implementing a telestroke network including studies between 2000 and 2010. At the time, telestroke networks were largely limited to the UK, USA, Canada and Europe and only one process evaluation had been conducted. Given the prolific expansion of telestroke services since 2010, we conducted a systematic review to determine factors associated with successful establishment, management, and sustainability of a contemporary telestroke services. A comprehensive search of telestroke studies was conducted in July 2021. Empirical studies published between 2010 and 2021 were included if they contained descriptive, evaluation or operational data on the implementation of a telestroke network. Studies were subsequently evaluated using the Consolidated Framework for Implementation Research (CFIR). The initial literature search revealed a total of 7415 potential studies; 38 of which met the inclusion criteria. The past decade of process evaluation studies has enabled a more nuanced investigations into how to implement and sustain a telestroke network. Pre-implementation planning is crucial to ensure clear telestroke processes, governance structures and stakeholder engagement. Sustainability of networks relies on securing long-term investment, providing adequate resources, and maintaining staff motivation and willingness. Recommendations are provided to overcome commonly identified barriers related to technology, staffing, planning and standardisation of processes, evaluation, and sustainability and scale-up. Further research needs to explore how new advancements in stroke care such as endovascular clot retrieval (EVT) and advanced brain imaging can be considered and planned for during the implementation of a new telestroke service.
远程卒中应用自 1999 年诞生以来已经相当成熟。目前，一些已发表的指南建议使用远程卒中。因此，没有远程卒中服务的司法管辖区正在寻求有关实施远程卒中的最佳方法的实用信息。French 等人（2013 年）回顾了实施远程卒中网络所面临的挑战，包括 2000 年至 2010 年的研究。当时，远程卒中网络主要局限于英国、美国、加拿大和欧洲，仅进行了一项流程评估。鉴于自 2010 年以来远程卒中服务的大量扩展，我们进行了系统评价，以确定与当代远程卒中服务的成功建立、管理和可持续性相关的因素。2021 年 7 月对远程卒中研究进行了全面搜索。如果包含关于远程卒中网络实施的描述性、评估或操作数据，则纳入 2010 年至 2021 年期间发表的实证研究。随后使用整合实施研究框架（CFIR）对研究进行评估。最初的文献检索显示共有 7415 项潜在研究；其中 38 项符合纳入标准。过去十年的流程评估研究使人们能够更细致地研究如何实施和维持远程卒中网络。实施前规划对于确保明确的远程卒中流程、治理结构和利益相关者参与至关重要。网络的可持续性依赖于确保长期投资、提供充足的资源以及保持员工的积极性和意愿。提供了建议以克服与技术、人员配备、规划和流程标准化、评估以及可持续性和扩大规模相关的常见障碍。需要进一步研究如何在新的远程卒中服务的实施过程中考虑和规划新的卒中治疗进展，如血管内血栓切除术（EVT）和先进的脑成像。
