Expand telestroke in all provinces to save lives, reduce disability
Widespread use of telestroke—two-way audiovisual linkups between neurologists in stroke centres and emergency rooms in underserved and rural areas—would save lives, reduce disability and cut health-care costs in all parts of Canada, according to a major national report released today at the Canadian Stroke Congress.
"The case for telestroke is compelling and the need is urgent," says Dr. Mark Bisby, who was commissioned by the Canadian Stroke Network to study services across Canada. He said that Canadians should be "scandalized" that telestroke is lacking in most parts of the country, including those that need it most.
The report calls for the expansion of the service in every province and the formation of a national telestroke support network to enable provinces to learn from each other and share resources.
"Research into telestroke has shown increased access to the clot-dissolving drug tPA that can reduce stroke damage," says Ian Joiner, director of Stroke at the Heart and Stroke Foundation. "We owe it to all Canadians to look at how best to integrate such innovative services into existing stroke networks and systems."
"In Canada, only two provinces have widespread telestroke for hyper-acute care – Ontario and Alberta – and the results have been dramatic," says Dr. Michael Hill, Co-chair of the Canadian Stroke Congress. "Underserviced provinces need to step up and deliver this low-cost, high-impact service."
Research has shown that, in Alberta, telestroke ensures rural and remote stroke patients get tPA at the same rate as those treated in larger centres. Besides providing better care, the service saved the Alberta health-care system more than $1 million over four years. The annual cost of running a telestroke site is $100,000 to $150,000, including equipment, operating and salary costs, according to the Bisby report.
A study presented at the Congress found an on-call neurologist using telestroke technology could treat patients in remote or understaffed regions with the same quality of care as patients admitted to specialized stroke centres. "This is no longer an experimental approach to stroke care delivery," says Dr. Frank Silver, University of Toronto, a leader of Ontario's telestroke program. "We're achieving the same outcomes as the best stroke centres in the province."
During a one-year period from 2010 to 2011, 12 stroke neurologists located in regional stroke centres, such as Ottawa and Toronto, treated 450 patients from 17 referring hospitals across the province. Neurologists were on call for a 24-hour period with access to telestroke technology either at home or at a hospital. A back-up neurologist from another area was always available in case of problems with the telestroke internet hook-up.
Of those patients, 42 per cent who arrived at hospital within the three-and-half-hour window of eligibility received the clot-dissolving drug tPA. At regional stroke centres, neurologists administered tPA to 48 per cent of eligible patients who arrived within the same time frame.
The Canadian Stroke Congress is a joint initiative of the Canadian Stroke Network, Heart and Stroke Foundation of Canada and Canadian Stroke Consortium.