title: Telemedicine physician providers: augmented acute stroke care delivery in rural Texas: an initial experience.
abstract: We describe the first report of intravenous thrombolytic therapy for acute ischemic stroke given by a rurally based advanced practice nurse (APN) with a telemedicine team of an emergency physician and stroke specialists. A three-way T1 connection between the APN in Dickerson Memorial Hospital in Jasper, TX, the Houston, TX-based Emtel emergency physician, and the University of Texas-Houston Stroke Team physicians facilitated tissue plasminogen activator treatment 80 min into the patient's ischemic stroke, which was manifested by dysarthria, facial palsy, and near-total left-body hemiplegia (NIH Stroke Scale = 9). She was transferred to Memorial Hermann Hospital in Houston for further care. Within 24 h, her neurologic deficits resolved (NIH Stroke Scale = 0), and she was discharged home within 3 days. This represents successful acute stroke care given by an APN under supervision of a telemedicine physician team and may be an option for underserved areas. Educational training of health care providers remains the key for acute stroke care delivery. This case report illustrates a model for telemedicine that has been cost-effective for rural medical care.
authors.affiliation: University of Texas Health Science Center at Houston, Houston, Texas 77030, USA. John.Y.Choi@uth.tmc.edu
authors.forename: John Y
authors.initials: JY
authors.lastname: Choi
authors.forename: Anne W
authors.initials: AW
authors.lastname: Wojner
authors.forename: Robert T
authors.initials: RT
authors.lastname: Cale
authors.forename: Peter
authors.initials: P
authors.lastname: Gergen
authors.forename: Joseph
authors.initials: J
authors.lastname: DeGioanni
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
mesh_terms: D000208:Acute Disease; D061605:Administration, Intravenous; D057179:Advanced Practice Nursing; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D019035:Rural Health Services; D020521:Stroke / Q000188:drug therapy*; D017216:Telemedicine; D013781:Texas; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents