Abstract
Objective. The objective was to define and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP) in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods. Prospective stroke alert patients at participating hospitals underwent a two-way audio video telemedicine consultation with a VN-NP at a remotely located stroke center in partnership with a vascular neurologist. Demographic information, National Institutes of Health Stroke Scale (NIHSS) scores, diagnoses, CT contraindications to thrombolysis, thrombolysis eligibility, and time interval data were collected. The inter-rater agreement between VN-NP and vascular neurologist assessments was calculated. Results. Ten patients were evaluated. Four were determined to have ischemic stroke, one had a transient ischemic attack, two had intracerebral hemorrhages, and three were stroke mimics. Overall, three patients received thrombolysis. The inter-rater agreement between VN-NP and vascular neurologist assessments were excellent, ranging from 0.9 to 1.0. The duration of VN-NP consultation was 53.2 ± 9.0 minutes, which included the vascular neurologist supervisory evaluation time of 12.0 ± 9.6 minutes. Conclusion. This study illustrated that a stroke center VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to remotely located rural emergency departments within a hub and spoke network. VN-NPs may fulfill the role of a telestroke provider.
Highlights
The purpose of this preliminary study was to define, demonstrate, and evaluate a role for the vascular neurology nurse practitioner (VN-NP) in the delivery of telemedicine consultations in partnership with a vascular neurologist in the context of an established hub and spoke stroke telemedicine network
Examples of physician—NP telemedicine partnerships already exist in rural emergency medicine, but none describe the potential role of a VN-NP telemedicine provider responding to cases of acute stroke
In the United States, it is estimated that NP and physician assistants (PAs) are involved in 1.8% and 6.5%, respectively, of emergency department consultations [2]
Summary
The purpose of this preliminary study was to define, demonstrate, and evaluate a role for the vascular neurology nurse practitioner (VN-NP) in the delivery of telemedicine consultations in partnership with a vascular neurologist in the context of an established hub and spoke stroke telemedicine network. NPs, physician assistants (PAs), and other physician extenders are no longer being relegated to subservient roles in health-care delivery. They are assuming an ever-increasing level of responsibility in patient care. With technological enablers, such as telemedicine, physician extenders’ future roles as specialty caregivers in rural communities will grow. Emergency medicine midlevel providers were positioned in the hospital; when or if, supervision was necessary, emergency physicians and/or medical or surgical specialists were consulted. In the published program, “TelEmergency for rural hospitals,” emergency NP collaborated with remote TelEmergency physicians to treat patients [4].
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