title: Rural Victorian Telestroke project.
abstract: BACKGROUND
  Intravenous thrombolysis improves functional outcomes in acute ischaemic stroke. However, many rural stroke patients are denied thrombolysis because of a rural neurologist shortage. 'Telestroke' facilitates thrombolysis by providing remote access to neurologists via videoconferencing systems.
  
  
  OBJECTIVE
  To develop a safe and feasible Telestroke system in a rural Victorian hospital that facilitates delivery of intravenous thrombolysis to acute ischaemic stroke patients.
  
  
  METHODS
  A pilot videoconferencing Telestroke system was set up between Royal Melbourne Hospital and Northeast Health Wangaratta. Acute stroke patients presenting within 4.5 h of symptom onset without intracranial haemorrhage were eligible for Telestroke. However, eligible patients were excluded from Telestroke if they had haemorrhagic risk factors. Data were collected from intervention (October 2009-September 2010) and control group (October 2008-September 2009) by medical file audit. Primary outcome measure was percentage of patients thrombolysed. Secondary outcome measures included incidence of symptomatic intracerebral haemorrhage and door-to-computed tomography time.
  
  
  RESULTS
  One hundred and forty-five acute stroke patients presented in control year and 130 patients in intervention year. Fifty-four patients in intervention and 36 patients in control group were eligible for thrombolysis. In intervention group, 24 patients had Telestroke activated and 8 patients underwent thrombolysis. There was no thrombolysis in the control group. There were neither symptomatic intracerebral haemorrhages nor deaths attributable to thrombolysis. Median door-to-computed tomography time did not significantly differ between eligible patients in control and intervention groups.
  
  
  CONCLUSIONS
  Telestroke has the potential to bridge the gap of rural-metropolitan inequality in acute stroke care. Our Telestroke system successfully introduced safe thrombolysis and early specialist review of acute stroke patients in rural Victoria.
authors: Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors: K J
authors: KJ
authors: Nagao
authors: A
authors: A
authors: Koschel
authors: H M
authors: HM
authors: Haines
authors: L E
authors: LE
authors: Bolitho
authors: B
authors: B
authors: Yan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012423:Rural Health / Q000639:trends*; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D017216:Telemedicine / Q000379:methods* / Q000639:trends*; D015912:Thrombolytic Therapy / Q000379:methods / Q000639:trends; D014739:Victoria / Q000453:epidemiology; D049269:Videoconferencing / Q000639:trends; D055815:Young Adult