• Smriti Agarwal, Diana J Day, Lynda Sibson, Patrick J Barry, David Collas, Kneale Metcalf, Paul E Cotter, Paul Guyler, Eoin W O'Brien, Anthony O'Brien, Declan O'Kane, Peter Owusu-Agyei, Peter Phillips, Raj Shekhar, and Elizabeth A Warburton.
• Clinical Neurosciences, University of Cambridge, UK.
• J Am Heart Assoc. 2014 Jan 1;3(1):e000408.

BackgroundThe majority of established telestroke services are based on "hub-and-spoke" models for providing acute clinical assessment and thrombolysis. We report results from the first year of the successful implementation of a locally based telemedicine network, without the need of 1 or more hub hospitals, across a largely rural landscape.Methods And ResultsFollowing a successful pilot phase that demonstrated safety and feasibility, the East of England telestroke project was rolled out across 7 regional hospitals, covering an area of 7500 square miles and a population of 5.6 million to enable out-of-hours access to thrombolysis. Between November 2010 and November 2011, 142 telemedicine consultations were recorded out-of-hours. Seventy-four (52.11%) cases received thrombolysis. Median (IQR) onset-to-needle and door-to-needle times were 169 (141.5 to 201.5) minutes and 94 (72 to 113.5) minutes, respectively. Symptomatic hemorrhage rate was 7.3% and stroke mimic rate was 10.6%.ConclusionsWe demonstrate the safety and effectiveness of a horizontal networking approach for stroke telemedicine, which may be applicable to areas where traditional "hub-and-spoke" models may not be geographically feasible.

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