Background: The majority of stroke patients admitted to regional hospitals have no access to bona fide stroke unit care despite the recent uptake of acute tele-stroke programs.
Aims: To describe the results of a 12-month, novel tele-stroke unit pilot at Echuca Regional Health.
Methods: Consultation data and admission episode variables were extracted. The variables analysed include age, sex, initial diagnosis, final working diagnosis, and other interventions provided by the BUILDS stroke neurologist.
Results: 120 consultations (71 video, 49 telephone) were conducted on 85 patients. Median age was 73 (IQR 65 – 92); youngest 38, oldest 98 years. The median time for pre-consultation discussion was 10 minutes (IQR 10 – 15). 78% (66/85) of initial consultations included a clinical review of the patient at the bedside using Zoom technology. The median time for the patient consult was 10 minutes (IQR 0-15).
A majority of clinical consultations were conducted with at least two local clinicians, typically the stroke coordinator and medical resident. Imaging was reviewed within the clinical context along with acute stroke education in 88% (106/120) of pre-consultation discussions. Patient centred counselling was provided by the stroke neurologist in 51% (61/120) of consultations at the bedside. 31% (26/85) of initial, and 20% (7/35) of follow-up consultations resulted in a diagnosis revision respectively. Medications were revised in 56 of 120 consultations (47%). 7 MRIs were requested and 10 cancelled. 4 hospital transfers were avoided, and 1 urgent transfer facilitated post consultation. Median length of stay was 3 days (IQR 2-5).
Conclusion:
BUILDS Tele-stroke Unit Care improved diagnostic accuracy and reduced unnecessary resource use leading to potential cost savings for the local health service. It is a viable model that can be used to improve access to stroke unit care in regional areas. Our vision is that this simple model is expanded Australia-wide to ensure all patients receive evidence-based Stroke Unit Care.