• Dominique A Cadilhac, Natasha Moloczij, Sonia Denisenko, Helen Dewey, Peter Disler, Bruce Winzar, Ian Mosley, Geoffrey A Donnan, and Christopher Bladin.
• Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia.
• Int J Stroke. 2014 Feb 1; 9 (2): 252-8.

RationaleUrgent treatment of acute stroke in rural Australia is problematic partly because of limited access to medical specialists. Utilization of telemedicine could improve delivery of acute stroke treatments in rural communities.AimThe study aims to demonstrate enhanced clinical decision making for use of thrombolysis within 4·5 h of ischemic stroke symptom onset in a rural setting using a telemedicine specialist support model.DesignA formative program evaluation research design was used. The Victorian Stroke Telemedicine program was developed and will be evaluated over five stages to ensure successful implementation. The phases include: (a) preimplementation phase to establish the Victorian Stroke Telemedicine program including the clinical pathway, data collection tools, and technology processes; (b) pilot clinical application phase to test the pathway in up to 10 patients; (c) modification phase to refine the program; (d) full clinical implementation phase where the program is maintained for one-year; and (e) a sustainability phase to assess project outcomes over five-years. Qualitative (clinician interviews) and quantitative data (patient, clinician, costs, and technology processes) are collected in each phase.Study OutcomesThe primary outcome is to achieve a minimum 10% absolute increase in eligible patients treated with thrombolysis. Secondary outcomes are utilization of the telestroke pathway and improvements in processes of stroke care (e.g., time to brain scan). We will report door to telemedicine consultation time, length of telemedicine consultation, clinical utility and acceptability from the perspective of clinicians, and 90-day patient outcomes.SummaryThis research will provide evidence for an effective telestroke program for use in regional Australian hospitals.© 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

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