Key Hospitalist Clinical Practice Guidelines in 2017

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO

Disclosures

January 16, 2018

In This Article

Telestroke Networks

Heart and Stroke Foundation Canadian Stroke Best Practice Committees

Telestroke networks should be implemented to provide access to stroke expert consultations for hyperacute and acute stroke assessment, diagnosis, and treatment, including acute thrombolytic therapy with tissue plasminogen activator (tPA) and decision-making for endovascular therapy.

Standardized, time-driven protocols are required for a coordinated and efficient approach to telestroke service delivery in the hyperacute phase of stroke to facilitate delivery of advanced stroke therapies in referring sites.

The consultant should be a physician with specialized training in hyperacute stroke management and must have timely access to diagnostic-quality neurovascular (eg, brain CT, CTA) images during the telestroke consultation.

Real-time two-way audiovisual communication should be in place to enable remote clinical assessment of the patient by the consulting stroke expert.

All laboratory and diagnostic results required by the consultant should be made readily available during the telestroke consultation.

Telehealth-enabling technologies, including real-time, two-way video conferencing with or without medical peripheral devices and potentially asynchronous (store-forward) tools, such as an e-referral system for non-urgent consultations and remote patient monitoring devices, can be used to enable consultations and/or service delivery regarding the following:

  • Optimal in-hospital stroke care (virtual stroke unit), including medical decision making and rehabilitation treatment.

  • Stroke rehabilitation services (telestroke rehabilitation), where all rehabilitation disciplines should consider the use of telemedicine technology for patient assessment and clinical therapies (eg, exercise monitoring and intensity adjustments, speech therapies for aphasia).

  • Secondary prevention consultation and follow-up services (virtual neurovascular clinic or stroke prevention clinic) in communities where these services do not exist.

  • Home-based patient monitoring through web-based applications may be considered as an alternative to face-to-face clinic visits in instances where frequent patient monitoring is necessary, such as for outpatient rehabilitation services.

  • Patients with reduced mobility in long-term-care facilities or those living at a prohibitive distance from the clinic/hospital.

Reference

  • Blacquiere D, Lindsay MP, Foley N, et al. Canadian Stroke Best Practice Recommendations: Telestroke Best Practice Guidelines Update 2017. Int J Stroke. Oct;12(8):886-95.

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