Victorian telemedicine program eliminates “postcode lottery” of acute stroke care

Tuesday, 21 Aug 2018

A telemedicine program has eliminated the “postcode lottery” of acute stroke care in Victoria and should now be rolled out across the country, a medical conference has been told.

Presenting an abstract at Stroke 2018 in Sydney, Professor Chris Bladin, from the department of neurosciences at Eastern Health, said reperfusion therapies were provided more often, more quickly and more safely across Victoria’s network of rural and regional hospitals since the introduction of the Victorian Stroke Telemedicine (VST) Program in 2011.

The program now provides 17 hospitals with 24-hour access to on-call Melbourne-based neurologists via video consultations, who can support assessment, diagnosis and treatment decisions in suspected stroke cases.

In a before-and-after analysis, outcome data was obtained for 2932 patients who presented to regional EDs with suspected stroke in the immediate 12 months before the program was implemented, and a further 3167 patients who presented during the first 12 months of the program’s operation.

For patients with a confirmed ischaemic stroke who arrived within 4.5 hours of symptom onset, this group showed a 51% greater odds of receiving thrombolysis with VST than pre-VST and a three times greater odds of door-to-needle times within 60 minutes with VST than pre-VST.

The odds of having an intracerebral haemorrhage after thrombolysis decreased by 76% with VST than pre-VST and since May 2015, 25% of thrombolysis cases were recommended for endovascular clot retrieval, which requires transfer to Royal Melbourne Hospital.

The program “has been incredibly successful and we think it lends itself to roll out across the rest of Australia,” Professor Bladin, who is director of the VST, told the limbic.

“There are many areas in Australia that are ‘no go zones’, you don’t want to have a stroke in that area because the stroke care is suboptimal. A lot of those zones are where people are retiring,” he said

Professor Bladin said the data from the VST showed that a stroke telemedicine service was able able to deliver best practice care to both small and large regional hospitals at a rate that is comparable to many Australian metropolitan centres and more than double the treatment rate seen in other regions.

“In Victoria we have every postcode covered, we know wherever you are in Victoria you will have access to a hospital that delivers acute stroke care, that hospital is able to contact a stroke expert to get significant input to making a diagnosis and the best course of treatment within a certain time frame.”

“Telemedicine has made a quite substantial difference to the delivery of acute stroke care across Victoria and in keeping with that we have had a lot of discussions with colleagues around Australia with trying to expand this to a national model.”

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