title: Development, Implementation, and Evaluation of a Telemedicine Service for the Treatment of Acute Stroke Patients: TeleStroke.
abstract: BACKGROUND
  Health care service based on telemedicine can reduce both physical and time barriers in stroke treatments. Moreover, this service connects centers specializing in stroke treatment with other centers and practitioners, thereby increasing accessibility to neurological specialist care and fibrinolytic treatment.
  
  
  OBJECTIVE
  Development, implementation, and evaluation of a care service for the treatment of acute stroke patients based on telemedicine (TeleStroke) at Virgen del Rocío University Hospital.
  
  
  METHODS
  The evaluation phase, conducted from October 2008 to January 2011, involved patients who presented acute stroke symptoms confirmed by the emergency physician; they were examined using TeleStroke in two hospitals, at a distance of 16 and 110 kilometers from Virgen del Rocío University Hospital. We analyzed the number of interconsultation sheets, the percentage of patients treated with fibrinolysis, and the number of times they were treated. To evaluate medical professionals' acceptance of the TeleStroke system, we developed a web-based questionnaire using a Technology Acceptance Model.
  
  
  RESULTS
  A total of 28 patients were evaluated through the interconsultation sheet. Out of 28 patients, 19 (68%) received fibrinolytic treatment. The most common reasons for not treating with fibrinolysis included: clinical criteria in six out of nine patients (66%) and beyond the time window in three out of nine patients (33%). The mean "onset-to-hospital" time was 69 minutes, the mean time from admission to CT image was 33 minutes, the mean "door-to-needle" time was 82 minutes, and the mean "onset-to-needle" time was 150 minutes. Out of 61 medical professionals, 34 (56%) completed a questionnaire to evaluate the acceptability of the TeleStroke system. The mean values for each item were over 6.50, indicating that respondents positively evaluated each item. This survey was assessed using the Cronbach alpha test to determine the reliability of the questionnaire and the results obtained, giving a value of 0.97.
  
  
  CONCLUSIONS
  The implementation of TeleStroke has made it possible for patients in the acute phase of stroke to receive effective treatment, something that was previously impossible because of the time required to transfer them to referral hospitals.
authors.affiliation: Virgen del Rocío University Hospital, Technological Innovation Group, Seville, Spain. carlos.parra.sspa@juntadeandalucia.es.
authors.forename: Carlos
authors.initials: C
authors.lastname: Parra
authors.forename: Francisco
authors.initials: F
authors.lastname: Jódar-Sánchez
authors.forename: M Dolores
authors.initials: MD
authors.lastname: Jiménez-Hernández
authors.forename: Eduardo
authors.initials: E
authors.lastname: Vigil
authors.forename: Alfredo
authors.initials: A
authors.lastname: Palomino-García
authors.forename: Francisco
authors.initials: F
authors.lastname: Moniche-Álvarez
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: De la Torre-Laviana
authors.forename: Patricia
authors.initials: P
authors.lastname: Bonachela
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Fernández
authors.forename: Aurelio
authors.initials: A
authors.lastname: Cayuela-Domínguez
authors.forename: Sandra
authors.initials: S
authors.lastname: Leal
keywords: Fibrinolysis; Standardization; Stroke; Telemedicine