Project Description

Telestroke Network Provides Modern Stroke Care in Non Urban Areas
The Telemedic Pilot Project of an Integrative Stroke Care in Eastern Bavaria (TEMPiS)

Johannes Schenkel, Heinrich J Audebert, Roman L Haberl
Department of Neurology
Klinikum Harlaching
Städtisches Klinikum München GmbH, Germany

Summary:

Modern stroke management requires specialized stroke care and advanced stroke expertise. In order to achieve these requirements in non urban areas two specialized stroke centers and 12 (meanwhile 15) general hospitals founded a telemedicine network (TEMPiS) in eastern Bavaria/Germany.
The telemedic system consists of a digital network including a 2-way video conference and CT/MRI-image transfer using a high-speed-data transmission up to 2 Mb/s. Each network hospital established specialized stroke wards where qualified teams treat acute stroke patients. The medical staff of the community-based hospitals completed a training program in state-of-the-art stroke treatment. Physicians in the local hospitals are able to contact the stroke centers 24 hours per day. Indications for telemedic support were predefined.
About 5000 stroke patients per year are treated in the network hospitals. Since Feb. 2003 about 3000 teleconsultations were performed and more than 200 patients received systemic thrombolysis every year.
Only about 5% of the patients were transferred to stroke centers to receive extended diagnostic or therapeutic procedures e.g. for malignant brain infarcts or basilar artery thrombosis. User and patient's satisfaction are very good concerning quality of consultation.
In an evaluation of the network treatment, procedures and outcomes were compared between TEMPiS hospitals and other hospitals without network participation. The results indicate that treatment quality according to established quality indicators was better in the network hospitals. The combined risk for death, institutionalized care and severe disability was much lower in patients admitted to TEMPiS-clinics.
Telemedicine combined with specialized stroke wards offers advanced stroke care in community hospitals. The telemedic approach provides rapid diagnostic and therapeutic support and is well accepted by the participants.
TEMPiS has become official part of the Bavarian modernization program for improved stroke care.

Views of hardware needed for Telestroke (A, B, C). A, Acute stroke patient in ER with treating physician. Video camera captures care, and computer screen can be turned on to view remote "stroke expert". B, Acute stroke patient in CT scanner with images to be transmitted to remote "stroke expert" (teleradiology). C, Remote "stroke expert" views patient and physician at treatment site and head CT films on computer screen with interactive software and video telecommunication.