Telestroke, also known as stroke telemedicine, is the technology that connects doctors with patients remotely through the use of video calls, telemedicine technology, and software. Doctors call the emergency department where the patient is present and are presented with all the relevant information via telestroke devices and software. 

This entire process is fast, efficient, effective, and allows for patients in remote, secluded hospitals to get quality care as well. Among the many benefits of telestroke care, one of the most important ones is the reduction in door-to-needle time. 

What is Door-to-Needle Time?

The concept of Door-to-needle time (DNT) in neurology is used in the management of Acute Ischemic Stroke (AIS). It refers to the time taken from the moment a patient presents with acute ischemic stroke symptoms to the start of the Intravenous thrombolysis (IVT). 

Promptly administering IVT is essential in managing AIS as IVT produces early arterial recanalization, which allows the reperfusion of the ischemic penumbral tissue, and this helps avoid it progressing to an infarction, effectively saving the patient. 

Therefore, the door-to-needle time has become the standard for evaluating hospitals' quality of acute stroke care. The lower the DNT, the higher the hospital is rated. 

Benefits of Telestroke

The nature of telestroke is such that everything is very direct. A patient gets admitted into the emergency department with stroke symptoms. The moment the emergency team is informed of the stroke symptoms (before the patient has even been placed in an ambulance), they can remotely call a teleneurologist and keep them on standby until the patient enters the ambulance. From that point forward, the teleneurologist can use the telestroke's readily available cameras, sensors, patient information, devices, and resources to quickly evaluate a patient and recommend the best course of treatment for them.

If the patient needs further tests for the teleneurologist to give a proper diagnosis and treatment method, the telestroke technology helps make the emergency department's plan of action for testing and patient assessment very quick. 

One of the common plans that the emergency department can initiate to reduce the door-to-needle time functions on these phases of action: 

Door-to-physician time

In this case, the physician is the teleneurologist, so the time taken is only a few minutes at max. The doctor can virtually assess the patient in the ambulance far quicker than even the fastest physical physician. This is made possible due to the virtual video call features available with telestroke technology. 

Door-to-stroke-team time

This is similar to the point above, in the sense that the stroke team can be immediately present virtually. This is especially necessary when the patient is being brought in from some far-away place, as the stroke team can start to make the specific treatment arrangements necessary for the patient before they even come by virtually assessing them. 

Door-to-initiation of a CT scan

The teleneurologist can ask the emergency department team to quickly get a CT scan machine and room ready so that the patient can be immediately taken in for the exam. Without the teleneurologist, the patient would first come to the emergency room, wait there for a physician, or might not even get a physician due to no physicians being on call, and then may be sent to get a CT scan after a long period. This problem does not exist with telestroke.

Door-to-CT interpretation time

The teleneurologist can get the CT scan results instantaneously through telestroke program  as the teleneurologist has access to all of the patient's relevant medical information. This ensures that no precious minutes are lost from getting a CT scan till it reaches a neurologist for interpretation.

The time between prescription and administration of treatment

After the teleneurologist gets all the available information, they can quickly recommend the appropriate treatment so that the patient doesn't lose any minutes in between.

The importance of the fast nature of telestroke can be visualized here, as each minute can lead to the death of 2,000,000 brain cells. Every minute saved is a chance that the patient does not develop permanent brain damage due to a lack of blood supply to the brain.

What Can You Do?

Reducing your hospital's door-to-needle time is an essential step every practice should take for their stroke care. The benefits of a faster door-to-needle time can only be understood when one understands that each minute you save in this process is the equivalent of saving somebody's memories, bodily functions, and who they are. The brain is one of the most important parts of our body, and as healthcare providers, it is our duty to provide the best quality care to protect it.

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