How Telehealth Can Help Stroke Patients in Rural Hospitals

Key TakeawaysThe COVID-19 pandemic has increased the need for telehealth services, especially in rural areas.Experts say that up to 80% of strokes are preventable.Telestroke gives rural hospitals access to stroke center experts 24 hours a day.

Key Takeaways

The COVID-19 pandemic has increased the need for telehealth services, especially in rural areas.Experts say that up to 80% of strokes are preventable.Telestroke gives rural hospitals access to stroke center experts 24 hours a day.

A new study from the University of Georgia has investigated the reasons whystrokepatients treated in rural hospitals have more negative outcomes and a higher risk of death.

Using data from the 2016 National Inpatient Sample, the study specifically looked at stroke patients who sought treatment in rural hospitals. The researchers identified several factors they believe contributed to the patients' poor outcomes, including the “weekend effect” and lack of resources. They also found that patients who had had ahemorrhagic strokehad particularly poor outcomes.

The findings highlighted the need for telemedicine and “telestroke” programs, which is one way to narrow resource and stroke specialist care gaps in rural communities.

Can You Have a Silent Stroke?

Rural Hospitals

Rural health facilities are often understaffed and not equipped to handle certain acute emergencies. This is especially true on weekends when thequality of careoften decreases.

To combat the gaps in care and quality, some facilities are joining telehealthcare networks that allow specialists to access a patient virtually at the bedside via video, review scans in real-time, collaborate with emergency room staff, and recommend a treatment plan. In some cases, that could mean arranging for a life-flight helicopter to transport a patient to a certified hospital with an experienced critical care team.

“Disparity is increased in rural areas.”Christina Mijalski Sells, MD, MPH, Stanford telestroke program medical director, tells Verywell. “[Patients in these areas] may have more baseline risks because of socioeconomic status and a decrease in resources. Telestroke can help reduce those risks.”

What Is a Stroke?

The American Stroke Association (ASA) lists stroke as the number five cause of death in the United States, but says that 80% of strokes are preventable.If a stroke is immediately diagnosed and treated, a person’s odds of surviving and recovering are better than if these interventions are delayed.

There are two types of strokes. The classification depends on the cause of the blockage. The most common types of strokes are:

In some cases, the cause of a stroke is not known. This is referred to as acryptogenic stroke.

Telestroke and Telemedicine

Telemedicine has been around for decades, but recent improvements in technology have allowed for expansion—particularly in the area of telestroke care.

How Telehealth Is Changing Medicine

Through a formal partner contract with hospitals, the multidisciplinary program can provide 24/7 expert on-call stroke specialists, staff training, and specific protocols. It also gives providers access to theInTouch Vici“robot," which lets stroke specialists use video and audio to communicate with doctors and patients, as well as to share pertinent health information instantaneously. This lets teams work together to create a treatment plan and ensure the continuation of care for patients.

A Real-World Example“We have seen great results with our telestroke program,” says Sells, who provided a real-life example of how the program benefitted a patient:“We had a patient at a hospital three hours away present to the emergency room with non-acute symptoms and we used telestroke to evaluate him and create a plan. Minutes later, a family member noticed a change in the patient that suggested more severe symptoms and they were able to quickly get in touch with our team. After evaluation, he was transported to our hospital via helicopter and we were able to utilize our team to initiate immediate treatment. He did great and walked out of the hospital upon discharge.”

A Real-World Example

“We have seen great results with our telestroke program,” says Sells, who provided a real-life example of how the program benefitted a patient:“We had a patient at a hospital three hours away present to the emergency room with non-acute symptoms and we used telestroke to evaluate him and create a plan. Minutes later, a family member noticed a change in the patient that suggested more severe symptoms and they were able to quickly get in touch with our team. After evaluation, he was transported to our hospital via helicopter and we were able to utilize our team to initiate immediate treatment. He did great and walked out of the hospital upon discharge.”

“We have seen great results with our telestroke program,” says Sells, who provided a real-life example of how the program benefitted a patient:

“We had a patient at a hospital three hours away present to the emergency room with non-acute symptoms and we used telestroke to evaluate him and create a plan. Minutes later, a family member noticed a change in the patient that suggested more severe symptoms and they were able to quickly get in touch with our team. After evaluation, he was transported to our hospital via helicopter and we were able to utilize our team to initiate immediate treatment. He did great and walked out of the hospital upon discharge.”

Increase in Telemedicine

Although telehealth technology is not new, theCOVID-19 pandemichas increased the need for physicians to be able to treat their patients from a distance as we try to slow the spread of the disease and avoid draining hospital resources.

The Center for Disease Control and Prevention (CDC) states that new pandemic policy changes have paved the way for telehealth to deliver acute, chronic, primary, and specialty care.Many professional medical societies now endorse telehealth and are providing guidance to clinicians on implementing the technology.

“The COVID-19 pandemic has had tremendous and multiple impacts on our healthcare system.” Donglan Zhang, PhD, co-author of the stroke outcomes study and assistant professor at the University of Georgia’s College of Public Health, tells Verywell. “Immediately after the COVID-19 outbreak, many healthcare systems experienced a rapid transition from in-person visits to virtual telehealth visits, which shifts the demand of care to telehealth through virtual face-to-face meetings using smartphones, tablets, or webcam-enabled computers.”

As with many facets of health care, some aspects of telehealth make it difficult to reach certain populations. There are alsocultural and technological barriers. In some cases, the technology is not well-suited to a case because there is sensitive information involved or it does not allow a clinician to perform an adequate physical assessment.

Despite these setbacks, Sells says that telehealth is here to stay.

“We are able to see a lot of patients this way,” she says. “It is a great alternative for those that can’t travel [a] long distance to our medical center.”

Stroke: Causes and Risk Factors

Stroke Risk Factors to Discuss During a Telehealth Visit

A majority of strokes are preventable. Certain health conditions and lifestyle habits can increase your chances of having a stroke. The ASA outlines the most common risk factors, many of which are related to lifestyle factors that you might be able to change.

Act FASTThe ASA uses the acronym FAST to help people quicklyidentify the symptoms of a stroke.Facedrooping: Is one side of the face drooping or numb? Ask the person to smile—is the smile even or lopsided?Armweakness:Is one arm weak or numb? Ask the person to raise both arms—does one arm drift downward?Speech:Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence.Timeto call 911:If the person shows any of these symptoms—even if the symptoms go away—call 911 and get them to a hospital immediately.

Act FAST

The ASA uses the acronym FAST to help people quicklyidentify the symptoms of a stroke.Facedrooping: Is one side of the face drooping or numb? Ask the person to smile—is the smile even or lopsided?Armweakness:Is one arm weak or numb? Ask the person to raise both arms—does one arm drift downward?Speech:Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence.Timeto call 911:If the person shows any of these symptoms—even if the symptoms go away—call 911 and get them to a hospital immediately.

The ASA uses the acronym FAST to help people quicklyidentify the symptoms of a stroke.

Timely Stroke Treatment

To increase the chance of survival and limit long-term effects, the ASA states that anischemic strokepatient has up to 4.5 hours from the onset of symptoms to receive an intravenous treatment of recombinanttissue plasminogen activator(r-tPA), which works to bust or remove the clot.

In some stroke patients, r-tPA can be used in combination with mechanical thrombectomy, which physically removes the clot using a wire-cage device called a stent retriever.The procedure should be done within six hours of onset of symptoms, but might be beneficial up to 24 hours after symptom onset.

Whichever treatment is used, time is the number one factor in successful stroke treatment. Telestroke can put a patient in front of a stroke specialist who can coordinate immediate treatment and increase the patient’s chance of survival.

What This Means For YouIf you or someone you know is having symptoms of a stroke, call 911 right away. You should be able to use FAST to help diagnose stroke symptoms, but a telehealth appointment can help you get the correct diagnosis and offer next steps if you’re not sure.

What This Means For You

If you or someone you know is having symptoms of a stroke, call 911 right away. You should be able to use FAST to help diagnose stroke symptoms, but a telehealth appointment can help you get the correct diagnosis and offer next steps if you’re not sure.

9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mekonnen B, Wang G, Rajbhandari-Thapa J, Thapa K, Zhang Z, Zhang D, et al.Weekend effect in-hospital mortality for ischemic and hemorrhagic stroke in US rural and urban hospitals. Journal of Stroke.105106.doi:10.1016/j.jstrokecerebrovasdis.2020.105106American Stroke Association (ASA).About stroke.Centers for Disease Control and Prevention.Types of stroke.Stanford Medicine—Neurology and Neurological Sciences.About the Stanford Stroke Center.The Centers for Disease Control and Prevention (CDC).Using telehealth to expand access to essential health services during the COVID-19 pandemic.American Stroke Association (ASA).Understanding stroke risk (brochure).American Stroke Association (ASA).Stroke symptoms.American Stroke Association (ASA).Why getting quick stroke treatment is important.American Stroke Association (ASA).Ischemic stroke treatment.

9 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mekonnen B, Wang G, Rajbhandari-Thapa J, Thapa K, Zhang Z, Zhang D, et al.Weekend effect in-hospital mortality for ischemic and hemorrhagic stroke in US rural and urban hospitals. Journal of Stroke.105106.doi:10.1016/j.jstrokecerebrovasdis.2020.105106American Stroke Association (ASA).About stroke.Centers for Disease Control and Prevention.Types of stroke.Stanford Medicine—Neurology and Neurological Sciences.About the Stanford Stroke Center.The Centers for Disease Control and Prevention (CDC).Using telehealth to expand access to essential health services during the COVID-19 pandemic.American Stroke Association (ASA).Understanding stroke risk (brochure).American Stroke Association (ASA).Stroke symptoms.American Stroke Association (ASA).Why getting quick stroke treatment is important.American Stroke Association (ASA).Ischemic stroke treatment.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Mekonnen B, Wang G, Rajbhandari-Thapa J, Thapa K, Zhang Z, Zhang D, et al.Weekend effect in-hospital mortality for ischemic and hemorrhagic stroke in US rural and urban hospitals. Journal of Stroke.105106.doi:10.1016/j.jstrokecerebrovasdis.2020.105106American Stroke Association (ASA).About stroke.Centers for Disease Control and Prevention.Types of stroke.Stanford Medicine—Neurology and Neurological Sciences.About the Stanford Stroke Center.The Centers for Disease Control and Prevention (CDC).Using telehealth to expand access to essential health services during the COVID-19 pandemic.American Stroke Association (ASA).Understanding stroke risk (brochure).American Stroke Association (ASA).Stroke symptoms.American Stroke Association (ASA).Why getting quick stroke treatment is important.American Stroke Association (ASA).Ischemic stroke treatment.

Mekonnen B, Wang G, Rajbhandari-Thapa J, Thapa K, Zhang Z, Zhang D, et al.Weekend effect in-hospital mortality for ischemic and hemorrhagic stroke in US rural and urban hospitals. Journal of Stroke.105106.doi:10.1016/j.jstrokecerebrovasdis.2020.105106

American Stroke Association (ASA).About stroke.

Centers for Disease Control and Prevention.Types of stroke.

Stanford Medicine—Neurology and Neurological Sciences.About the Stanford Stroke Center.

The Centers for Disease Control and Prevention (CDC).Using telehealth to expand access to essential health services during the COVID-19 pandemic.

American Stroke Association (ASA).Understanding stroke risk (brochure).

American Stroke Association (ASA).Stroke symptoms.

American Stroke Association (ASA).Why getting quick stroke treatment is important.

American Stroke Association (ASA).Ischemic stroke treatment.

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