Abstract
Background: Telestroke has significantly improved acute stroke care in intensive care and inpatient settings, but post discharge care has been lacking and fragmented resulting in poor secondary stroke prevention, post-stroke complications, and inadequate patient education. Immediate need for stroke follow up ignited the development of telemedicine outpatient stroke clinics led and managed by nurses and nurse practitioners. Nurses identified these gaps and advocated for telestroke clinics in rural areas. Purpose: The purpose of this program was to develop a nurse led telemedicine outpatient stroke clinic and improve access to expert neuro consults. Methods: Through affiliate relations with healthcare facilities and nurse advocacy, the continuity of stroke care in local communities was expanded to 2 telemedicine outpatient clinics. A specialized nurse practitioner was credentialed, privileged, and trained to conduct telemedicine appointments. Telehealth nurse coordinators trained clinics on the neurological assessment and telepresenter role. Data was analyzed assessing appointment compliance rates, miles saved, and cost of travel. Results: Between October 2017 and August 2018, 48 patients were seen at nursing led telestroke outpatient clinics. Data showed a decrease in no show appointments from fiscal year 2016 (16.29%) to 2018 (15.3%). On average, patients saved 5896 miles round trip (122.8 miles per patient) and saw a cost savings of $655.11 in gas (at $2.50/gallon). Community facilities received downstream revenue from ancillary studies; however, coordinating pre appointment scans initially exhibited interruptions in patient care. Further challenges included training clinicians on technology platforms, while simultaneously assisting remote neuro specialists with hands on patient assessments. Conclusion: Nursing advocacy for the development of telestroke outpatient clinics has shown promising improvements in no show appointment rates, increased access to specialty care, and reduction in travel burdens. Further growth and expansion of telemedicine outpatient clinics by nurses is essential in providing a holistic approach for specialized patient care and empowering nurses to be an advocate in the continuum of stroke care.
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