Treating acute ischemic stroke with intravenous TPA (tissue plasminogen activator) is a complex process. While this clot-busting drug can help patients, it should not be given to just any patient since it can also lead to life-threatening bleeding within the brain or elsewhere. Since the drug must be given within 4.5 hours of an ischemic stroke, and since there are so many possible exclusions, the decision-making can become intense.
This situation is compounded by the frequent unavailability of stroke neurologists at the bedside to evaluate acute stroke patients and review their head CT scans and other data.
Enter the American Stroke Association's (ASA) recent endorsement of high-quality video-teleconferencing (HQ-VTC). HQ-VTC, which basically involves a high quality video camera and two-way voice communication, puts the stroke neurologist (where ever he may be) in direct communication with the patient, his or her family, and the treating emergency room physicians. Also required is a way for the neurologist to review the head CT results.
The ASA's scientific statement reviewed multiple studies of the feasibility and outcomes from the use of teleconferencing technology. They ultimately recommended the use of this technology, feeling that if a stroke neurologist was not immediately available, this technology provided an excellent means of patient evaluation.
I think a widespread implementation of this technology would benefit hospitals, neurologists, and patients. Hospitals often have a difficult time getting neurologists to be quickly available for stroke evaluations. Why might this be?
The main reason is that most neurologists are not in the hospital, but are in their clinics seeing patients. Getting to the hospital may involve canceling the appointments of their clinic patients, traveling to the hospital, and then becoming involved in a time-consuming process of stroke evaluation. To avoid this, most neurologists will instead attempt to perform this evaluation over the phone, by having the emergency room physician perform the evaluation, by having a radiologist read the CT scan, and by reviewing the other data collected by the emergency room. The ASA report indicates that this type of evaluation is less than ideal. Furthermore, many ER physicians don't feel comfortable giving a potentially dangerous drug (TPA) without a neurologist actually being present. High quality videoteleconferencing solves this problem for hospitals, patients, and stroke neurologists.