Vascular neurology nurse practitioner provision of telemedicine consultations.
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.
Demaerschalk
Bart M
BM
Division of Cerebrovascular Diseases and Division of Critical Care Neurology, Department of Neurology, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
Kiernan
Terri-Ellen J
TE
J Contin Educ Nurs. 2003 Sep-Oct;34(5):226-33
14518639
Hawaii Med J. 2005 May;64(5):116
15989142
Stroke. 2010 Jun;41(6):1251-8
20431081
Psychiatr Serv. 2006 Jan;57(1):138
16399978
Aust J Rural Health. 2007 Dec;15(6):346-51
17970896
J Stroke Cerebrovasc Dis. 2008 Jul-Aug;17(4):181-6
18589337
Mayo Clin Proc. 2009;84(1):53-64
19121244
Crit Care Nurs Clin North Am. 2009 Dec;21(4):435-49
19951762
Am J Emerg Med. 1996 May;14(3):245-9
8639193
AACN Clin Issues. 2005 Jan-Mar;16(1):16-22
15714014
Neurology. 2005 Mar 22;64(6):1058-60
15781827
Telemed J E Health. 2009 Sep;15(7):691-9
19694588
Acad Med. 2001 Jun;76(6):652-5
11401815
Ann Emerg Med. 2008 Mar;51(3):275-84
17764784
Lancet Neurol. 2008 Sep;7(9):787-95
18676180