24.: Feasibility of an international telestroke service: Initial treatment outcomes

Abstract

This study explored the feasibility of a cost neutral reciprocal international arrangement between a Scottish and a New Zealand stroke service providing a telestroke service to each other’s patients during the night-time period, taking advantage of international time zone differences. Following a complex implementation phase related to anticipated medico-legal issues we conducted a 16 week non-randomised observational feasibility pilot on weekdays from 9pm to 9am. Patients were recruited prospectively and both patients and medical staff were interviewed following assessment. Time frames and outcomes were captured. Five patients were assessed by an overseas consultant utilising telestroke. Two of these were treated and both experienced excellent recovery. Reasons for not treating the other three were spontaneous symptom resolution, intracerebral haemorrhage, and non-organic presentation. Both patient and staff feedback have been positive and supportive without any significant concerns raised. No significant technical issues occurred. Referral to treatment times were 63 and 50 minutes; these time frames are similar when patients are assessed locally and the delays relate primarily to obtaining brain imaging after hours as a technician has to drive in from home. These preliminary findings indicate that an international telestroke service is feasible. A much larger study is planned to more comprehensively assess treatment delays, patient outcomes, and service costs.