Thrombolysis delivery by a regional telestroke network--experience from the U.K. National Health Service.

The 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. following 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%. we 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.