Bridging the Urban and Regional Divide in Stroke Care (BUILDS): A Novel Telestroke Unit Service.

PROBLEM

People living in rural areas of Australia have an increased risk of stroke. Reperfusion decision support is increasingly available in these areas however, access to acute stroke unit care is limited.

SETTING

An acute telestroke unit pilot was implemented in a regional health service in Victoria.

KEY MEASURES FOR IMPROVEMENT

Change in diagnosis post specialist evaluation, patient and staff satisfaction, length of stay, percentage of patients discharged with anti-platelets and care plan provision.

STRATEGIES FOR CHANGE

Partnership between metro-based stroke specialists and an onsite stroke coordinator based in a regional site. Early engagement of key decision makers (i.e., hospital executive).

EFFECTS OF CHANGES

This model increased diagnostic accuracy and decreased resource use including diagnostic tests, patient transfers and staff deployment. Patients, families and staff reported high levels of satisfaction. The pilot transitioned to a sustainable health service funded model, embedded into 'usual' care. The BUILDS pilot enabled stroke unit certification of the regional health service.

LESSONS LEARNT

Telestroke unit model, enabled by an adequately resourced local stroke coordinator, could be the key to ensure all regional Australians have access to stroke unit care.