By Mayo Clinic Staff
In stroke telemedicine, also called telestroke, doctors who have advanced training in the nervous system (neurologists) remotely evaluate people who've had acute strokes and make diagnoses and treatment recommendations to emergency medicine doctors at other sites. Doctors communicate using digital video cameras, Internet telecommunications, robotic telepresence, smartphones, tablets and other technology.
Stroke telemedicine is a field requiring specialized, coordinated care. Mayo Clinic neurologists trained in blood vessel conditions (vascular neurologists), brain surgery (neurosurgeons), brain imaging (neuroradiologists) and those in stroke telemedicine centers work as a team with emergency medicine doctors and staff at remote sites, treating hundreds of stroke patients every year.
Mayo Clinic's campuses in Arizona, Florida and Minnesota, and at Mayo Clinic Health System in Eau Claire, Wisconsin, are certified as primary stroke centers by The Joint Commission, a national organization that evaluates and accredits health care providers.
- Our mission to find and share medical expertise means close contact with people working to discover better methods of caring for people who have had a stroke. Past research led to today's state-of-the-art stroke telemedicine network to help diagnose and treat strokes. Our commitment to expand knowledge for all stroke patients drives current research.
- By growing our network, we hope to help as many people as possible. Doctors at Mayo Clinic in Arizona began participating in stroke telemedicine as a trial in 2007. Since then, telestroke doctors at Mayo Clinic campuses in Arizona, Florida and Minnesota assess and treat over 3,000 patients annually at nearly 50 remote hospital sites across 11 states.
- Care at Mayo Clinic revolves around you. Mayo Clinic stroke telemedicine staff gives you individualized care and serves you in your community.
In stroke telemedicine (telestroke) at Mayo Clinic, your doctor and the neurologist trained in blood vessel conditions (vascular neurologist) provide care in your home community and try to avoid the need for transfer to another medical center. This focus on regional care often allows you to receive quality stroke care in your community.
Stroke telemedicine operates on a hub-and-spoke system. A large urban medical center, generally certified as a primary or comprehensive stroke center, usually serves as the primary medical center (the hub). Remote locations, usually smaller regional rural or underserved hospitals, serve as the spokes.
Many regional hospitals don't have neurologists on call to recommend the most appropriate care. In stroke telemedicine, a vascular neurologist at the hub consults with doctors and people who've had acute strokes at the remote sites (spokes).
In telestroke, many people work together as a team, including a program manager, a clinical coordinator, vascular neurologists, neurosurgeons and radiologists at the hub site, and emergency medicine doctors and other staff at the spoke site. Radiology technicians, informational technology staff, researchers, nurses, nurse practitioners and other staff also are important members of the stroke telemedicine team.
Stroke telemedicine consultation
In a stroke telemedicine consultation, an emergency medicine doctor at your regional hospital (the spoke) will examine you. If your doctor suspects an acute stroke, he or she will activate the stroke telemedicine hotline at the hub hospital, which has a dedicated hotline and group paging system and vascular neurologists on call 24 hours a day, 365 days a year. The hub's on-call vascular neurologist usually responds within five minutes.
After you have a CT scan at the spoke hospital, the vascular neurologist at the hub performs a live, real-time audiovisual consultation. The vascular neurologist may discuss your medical history and review your test results.
The vascular neurologist evaluates you, works with your doctor to determine the most appropriate treatment and sends the treatment recommendation electronically to the spoke hospital.
Having a prompt evaluation increases the possibility that clot-dissolving therapies (thrombolytics) can be delivered in time to reduce stroke-related disability. To be effective, clot-dissolving therapies must be given within three hours after you experience stroke symptoms.
Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.
Doctors trained in neurology, neurosurgery, emergency medicine, radiology and other areas participate in stroke telemedicine at Mayo Clinic in Arizona.
Since 2011, doctors have conducted thousands of stroke telemedicine consultations and administered clot-dissolving therapies (thrombolytics) to hundreds of people with acute strokes.
Doctors at Mayo Clinic in Arizona first began participating in stroke telemedicine as a trial in 2007, and established the Stroke Telemedicine for Arizona Rural Residents (STARR) network later that year. The stroke telemedicine program has since expanded to include 9 remote sites (spokes) in Arizona and three remote sites in Nevada. Doctors are actively involved in stroke telemedicine research.
For more information about stroke telemedicine at Mayo Clinic in Arizona contact 480-301-9145.
Doctors trained in vascular neurology, endovascular neurosurgery, interventional radiology, emergency medicine and other areas participate in stroke telemedicine at Mayo Clinic in Florida.
Since the stroke telemedicine program began in Florida, doctors at Mayo Clinic have performed over a thousand stroke telemedicine consultations and administered clot-dissolving therapies (thrombolytics) to more than 100 people with acute strokes. Currently the program has four remote sites (spokes), and additional spokes are in development.
For more information about stroke telemedicine at Mayo Clinic in Florida, contact 904-953-2272.
Doctors trained in neurology, neurosurgery, emergency medicine, radiology and other areas participate in stroke telemedicine at Mayo Clinic in Minnesota.
Mayo Clinic in Rochester, Minnesota, is a stroke telemedicine hub, serving 18 hospitals in the Mayo Clinic Health System in Minnesota and Wisconsin and one site in Iowa.
For more information about stroke telemedicine at Mayo Clinic in Minnesota, contact 507-284-1588.
See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.
Mayo Clinic researchers actively study stroke telemedicine (telestroke) and acute stroke care.
Mayo Clinic doctors incorporate training in remote evaluation of stroke and other acute neurological conditions in some residency and fellowship programs.
Read Mayo Clinic publications at PubMed, a service of the National Library of Medicine.
Oct. 20, 2015
- Rubin MN, et al. The use of telemedicine in the management of acute stroke. Neurosurgery Focus. 2014;36:E4.
- Zhai Y, et al. Efficacy of telemedicine for thrombolytic therapy in acute ischemic stroke: A meta-analysis. Journal of Telemedicine and Telecare. 2015;21:123.
- Quality check. The Joint Commission. http://www.qualitycheck.org/consumer/searchResults.aspx?zip=&dist=-1&idx=0&s=-1&st=&st_nm=-1&careId=&careGrpId=&provId=&provGrpId=&settingId=&populationId=&nm=Mayo+Clinic&cty_id=-1&cty_nm=&provIdtracker=&provGrpIdtracker=&careIdtracker=&careGrpIdtracker=&DecisionType=. Accessed Aug. 9, 2015.
- Riggin EA. Enterprise Performance Management system. Mayo Clinic, Rochester, Minn. Aug. 10, 2015.
- Huddleston P, et al. Stroke care using a hub and spoke model with telemedicine. Critical Care Nursing Clinics of North America. 2014;26:469.
- Stroke: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/stroke/detail_stroke.htm. Accessed Aug. 10, 2015.
- Demaerschalk BM, et al. Stroke telemedicine. Mayo Clinic Proceedings. 2009;84:53.
- Demaerschalk BM (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 20, 2015.
- Barrett KM (expert opinion). Mayo Clinic, Jacksonville, Fla. Aug. 31, 2015.
- Brown RD (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 31, 2015.