Evaluation of a French Regional Telemedicine Network Dedicated to Neurological Emergencies: A 14-Year Study.

BACKGROUND: Equality in healthcare between urban and rural areas is problematic in France. Telemedicine networks are expected to improve equality in expertise assessment. We aimed to evaluate the use and impact of a regional rural French telemedicine network, dedicated to medical and surgical neurological emergencies, on interhospital patient transfers. METHODS: Eight community hospital emergency departments were remotely connected to the only university hospital in Franche-Comté, France. We prospectively obtained data from all patients consecutively admitted to emergency care departments in the region and who received medical or neurosurgical expertise by telemedicine from January 2002 to December 2015. The reasons for requesting expertise, number of requested neurological opinions, and interhospital patient transfers were analyzed. Economic savings were determined by estimating the cost of avoided transfers. RESULTS: A total of 23,710 patients had telemedicine consultations in the region. The network was used by every community hospital (independently of the existence of local neurological teams). These consultations were overwhelmingly for cases of stroke (30%) and head or spinal injuries (36%). Cerebral tumors represented 9% of teleconsultations. In 2015, 75% of patients admitted to the remote hospitals that did not have onsite neurological expertise nevertheless received neurovascular tele-expertise. The rate of thrombolyzed patients dramatically increased within 13 years regionally (9.9%) and 33.5% of thrombolyses were performed by telemedicine. The number of patients examined by telemedicine and admitted for head or spinal injuries also increased over the 13-year period (12% vs. 21%). Secondary interhospital transfers were halved for both pathologies. The estimated saving is ∼€3.5 million. CONCLUSION: Telemedicine networks facilitate acute-phase neurological assessment and prevent unnecessary secondary interhospital transfers.

[Telemedicine: application in the neurological emergencies]. / Télémédecine : application aux urgences neurologiques.

Telemedicine covers different fields going from teleconsultation to tele expertise. Thanks to different national and international studies, telemedicine applied to stroke (telestroke) should be considered as reliable, sure and efficient. Securized specific networks and standardised procedures are required. Telestroke can be used at each stage of stroke and every kind of stroke can benefit this technic. The main limitation is the lack of specific financial retribution.

Telemedicine in stroke: organizing a network--rationale and baseline principles.

Telestroke is the specific term used for the application of telemedicine in stroke. It is a consultative modality that facilitates care of patients with acute stroke at underserved hospitals by specialists at stroke centers and can play a vital role in minimizing the overall medicosocial impact of stroke. Telestroke should not be viewed as a new form of stroke therapy, rather as a means of supporting the increased delivery of evidenced-based medicine in stroke. The design and implementation of a hub-and-spoke telestroke network are complex and require state-of-the-art technology and close, organized collaboration between healthcare professionals if they are to be achieved. Telestroke is becoming part of clinical practice in some regions. It provides rapid access to specialized treatment and it could also potentially lead to major improvements in basic on-site management. Telemedicine is also being used for secondary prevention, rehabilitation, education and long-term stroke care. However, for progress to continue and in order to ensure the long-term sustainability of telestroke, various medicolegal, economic and market issues need to be resolved.