title: Thrombolysis delivery by a regional telestroke network--experience from the U.K. National Health Service.
abstract: BACKGROUND
  The majority of established telestroke services are based on "hub-and-spoke" models for providing acute clinical assessment and thrombolysis. We report results from the first year of the successful implementation of a locally based telemedicine network, without the need of 1 or more hub hospitals, across a largely rural landscape.
  
  
  RESULTS
  Following a successful pilot phase that demonstrated safety and feasibility, the East of England telestroke project was rolled out across 7 regional hospitals, covering an area of 7500 square miles and a population of 5.6 million to enable out-of-hours access to thrombolysis. Between November 2010 and November 2011, 142 telemedicine consultations were recorded out-of-hours. Seventy-four (52.11%) cases received thrombolysis. Median (IQR) onset-to-needle and door-to-needle times were 169 (141.5 to 201.5) minutes and 94 (72 to 113.5) minutes, respectively. Symptomatic hemorrhage rate was 7.3% and stroke mimic rate was 10.6%.
  
  
  CONCLUSIONS
  We demonstrate the safety and effectiveness of a horizontal networking approach for stroke telemedicine, which may be applicable to areas where traditional "hub-and-spoke" models may not be geographically feasible.
authors.affiliation: Clinical Neurosciences, University of Cambridge, UK.
authors.forename: Smriti
authors.initials: S
authors.lastname: Agarwal
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Day
authors.forename: Lynda
authors.initials: L
authors.lastname: Sibson
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Barry
authors.forename: David
authors.initials: D
authors.lastname: Collas
authors.forename: Kneale
authors.initials: K
authors.lastname: Metcalf
authors.forename: Paul E
authors.initials: PE
authors.lastname: Cotter
authors.forename: Paul
authors.initials: P
authors.lastname: Guyler
authors.forename: Eoin W
authors.initials: EW
authors.lastname: O'Brien
authors.forename: Anthony
authors.initials: A
authors.lastname: O'Brien
authors.forename: Declan
authors.initials: D
authors.lastname: O'Kane
authors.forename: Peter
authors.initials: P
authors.lastname: Owusu-Agyei
authors.forename: Peter
authors.initials: P
authors.lastname: Phillips
authors.forename: Raj
authors.initials: R
authors.lastname: Shekhar
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Warburton
mesh_terms: D039602:After-Hours Care; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D004739:England; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006297:Health Services Accessibility; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012040:Regional Health Planning; D019114:Remote Consultation; D012111:Residence Characteristics; D019035:Rural Health Services; D013222:State Medicine; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D017216:Telemedicine / Q000379:methods*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: NHS; telestroke; thrombolysis