There are three parts to Telestroke: the consulting hospital where the neurologist or stroke specialist works; the referring hospital, where the patient is located; and the secure information and communication technology that connects the two.

Emergency physicians in the referring hospital run appropriate tests on the patient. The referring site connects to the neurologist in the consulting hospital by video link and the patient’s brain CT and test results are electronically forwarded.

The neurologist reviews the CT and the test results to determine if the patient has had an ischemic stroke (a stroke caused by a blood clot) , takes a patient history and assesses the patient by video to determine stroke severity, and makes a recommendation on whether to treat the patient with tPA -- a clot-busting drug.

These hospitals are in large urban centres and have one or more practicing neurologists and stroke specialists.

The hospital has a special section dedicated to Telestroke, and contains a computer with access to a patient’s brain scan and test results; a video camera and monitor that allows the people in the consulting and referring hospitals to see and hear each other; and a telephone line for back up communication.

Designated referring hospitals have no neurologist on staff, but have committed space and equipment for Telestroke consults. Emergency room physicians will work with a neurologist in a consulting hospital to help diagnose and treat a stroke.

If the emergency room physician suspects that a patient may have had an acute ischemic stroke (one caused by a blood clot or blockage of blood flow to the brain), he or she will call the Telestroke phone number. This alerts the neurologist on duty that they have a Telestroke patient.

The emergency room physician will order tests on the patient and send the results to the neurologist. The neurologist reviews the test results and, using videoconferencing equipment, will examine the patient, asking questions and noting responses.

If the neurologist concludes that the patient has suffered a stroke, he or she may prescribe Tissue Plasminogen Activator (tPA), a powerful drug that can dissolve blood clots, opening the blood flow to the brain. tPA will be administered by the emergency room physician.

Tissue Plasminogen Activator (tPA) is a powerful drug that dissolves blood clots, restores blood flow to the brain and greatly reduces the disabilities resulting from a stroke. It can only be administered under very specific conditions: patients with ischemic strokes (caused by blood clot, not by internal bleeding); within 4.5 hours of the onset of symptoms; and only to patients who are not at risk of internal or unstoppable bleeding (hemophiliacs taking certain types of medications, for example).

Telestroke has been recognized by the Canadian Stroke Strategy as a best practice. Both Alberta and Ontario have implemented provincial Telestroke systems. Telestroke has been widely implemented throughout the continental United States and in Europe.

The vast majority of strokes are ischemic, caused by blood clots that block the flow of blood – and oxygen – to the brain. One of the most effective treatments is Tissue Plasminogen Activator (tPA), which dissolves the clot. Neurologists in Vancouver and Victoria hospitals have prescribed tPA many times, and are experienced in identifying which patents would benefit. Using Telestroke technology to examine patients in rural communities and review their test results, neurologists can identify which patients would benefit from tPA.

All test results and video conferencing links are carried over secure health authority networks.

The British Columbia government has provided $7 million to fund the BC Stroke Strategy. Telestroke is one of several initiatives to help British Columbians become aware of the risks of stroke, recognize and get treatment when they are having a stroke, and recover from the effects of stroke.