The NSW Telestroke Service: A cross-agency collaboration to implement and sustain a virtual care hyperacute stroke service at 23 regional and rural hospitals

ABSTRACT

Background: The $21.7 million NSW Telestroke Service was a 2019 NSW Government election commitment. Implementation of the service is a collaboration between South Eastern Sydney Local Health District, the NSW Agency for Clinical Innovation, eHealth NSW and the NSW Ministry of Health. Between March 2020 and June 2022, the telestroke service launched at 23 sites across regional and rural NSW, providing access to specialist stroke physicians for rapid assessment, diagnosis and treatment through virtual care. The service has treated over 2200 patients with a reperfusion rate for acute ischaemic stroke patients of 34%. Aim(s) To understand the factors driving the successful implementation of a major project led by multiple health organisations in a complex environment. Interrogating and documenting the success factors will help NSW Health agencies implement similar large-scale, complex projects. Method(s) The implementation team adopted a reflective approach to draw out key lessons during the implementation at each site. Lessons learnt discussions were held at a local and program-wide level, focusing on areas including resourcing, leadership, education and training, and sustainability. Result(s) Key elements of successful implementation highlighted by the reflective lessons learnt approach include * Division of responsibility that reflected the strengths of each partner agency * Clear implementation roadmap including comprehensive implementation and training packages * Flexibility to adapt the implementation approach based on contextual factors and intervening events * Strong executive support at each partner agency * Upfront focus on sustainability to identify and mitigate issues early on The telestroke service was implemented by the target schedule, despite the significant impacts caused by the COVID-19 pandemic and natural disasters. The service was a finalist in the 2021 NSW Premier's Awards. Conclusion(s) The implementation of telestroke can offer insights for partner agencies into the key factors driving success of transformative projects to improve access to healthcare.