During the progression of a stroke, nervous tissue is lost rapidly and permanently. This suggests that for stroke diagnosis and treatment, time is of the essence (Saver, 2006). Fortunately, telemedicine for stroke patients can help specialists to evaluate a patient immediately, while emergency assistance is on its way, significantly decreasing the likelihood of serious and life-threating effects.
Telemedicine has been defined as the use of the transference of medical information remotely from one site to another using various electronic communication devices such as smart phones, web cams, robotic telepresence, and email (American Telemedicine Association, 2012). One common model for telemedicine is known as Hub and Spoke. The Hub and Spoke
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Telemedicine is usually comprised of an organized cross-functional team: Physicians who specialize in neurology and can make diagnoses and authoritative decisions regarding the treatment of the patients; Emergency Medical Services personnel who facilitate the transport, care and the administering of emergency medications; and other remote administrative and medical staff who perform various tasks. These staff include: vascular neurologists, neurosurgeons, and neuro-radiologists. Those in stroke telemedicine centers work as a team with emergency medicine doctors and staff at remote sites, treating hundreds of stroke patients every year. This can mean the difference in the preservation of a patient’s quality of life or the patient’s survival (Mayo Clinic, …show more content…
The primary motivation for telestroke was to increase the applicable use of intravenous tissue plasminogen activator (tPA) in patients with acute ischaemic stroke (Hess & Audebert, 2013). Ischemic stroke occurs when a blood vessel carrying blood to the brain is obstructed by a blood clot (National Stroke Association, 2016). The ‘time is brain’ concept was more fully understood and this strengthened the use of the tPA. Since then, technology advances have alleviated some of the telestroke challenges caused by geographic disparity in certain regions by expanding its availability. Subsequently, this practice has become more widely accepted by insurance companies, enabling its access to an increasing number of stroke patients (Hess & Audebert, 2013). In the long-term, telestroke can be very cost-effective so long as the network is well organized and primed for adeptness. A physician’s ability to see patients remotely allows him or her to see more patients and observe them more frequently, increasing the level of care received. Additionally, the reduced overhead costs foster operational efficiency by eliminating some expenditures. This is a mutually advantageous solution for rural patients hampered by time/distance constraints and commute expenses (Mayo Clinic,
The economic impact of telehealth is a critical factor to examine when looking at the feasibility of incorporating such technologies into practice. Exploration of economics is also essential as it has been posited that telehealth has the potential to deliver care to individuals that is cost saving in nature (Wade, Karnon, Elshaug, & Hiller, 2010). Furthermore, the estimated expenditure on telehealth services and technology is expected to reach into the billions of dollars (Berger, 2010). However, there are myriad individual elements that may be considered in the broad subject of economics, which complicates determining the economic impact in a parsimonious way (Bergmo, 2009; Wade, et al., 2010).
Globally the leading reason for mortality and morbidity rate is stroke. Nearly twenty million individuals can suffer from stroke annually and around five million individuals won't survive [1]. The developing countries account for a median of 85% of worldwide deaths from stroke [2]. Stroke ends up in practical impairments with a median rate of two hundredth survivors who need institutional care once an amount of three months and 15%-30% are going to be disabled for good [3].
“Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status” (Wager, Lee, & Glaser, 2013, p. 156.)
A Stroke Nurse Practitioner can also be found in areas of both primary and secondary prevention where he or she makes certain that each patient is evaluated and preventative therapies are implemented. Such assessments include brain imaging, dysphagia and hypertension screening. In addition, this NP can act as a coordinator for stroke patients from admission to discharge by meeting with families and rehabilitation centers and providing information and resources to the post stroke patient. This NP is the gateway to educating the nursing staff in recognizing the signs and symptoms of stroke and implementing the facilities stroke protocol.
Telehealth is the monitoring via remote exchange of physiological data between a patient at home and health care professionals at hospitals or clinics to assist with diagnosis and treatment. As our society ages and health care costs increase, government and private insurance payers are seeking technological interventions. Technological solutions may provide high quality healthcare services at a distance, utilize professional resources more effectively, and enable elderly and ill patients to remain in their own homes. Patients may experience decreased hospitalization and urgent care settings, and out of home care may not be required as the patient is monitored at home. However, no study has been able to prove telehealth benefits conclusively. This change in health care delivery presents new ethical concerns, and new relationship boundaries between health care professionals, patients, and family members. This paper will discuss telehealth benefits in specific patient populations, costs benefits of using telehealth, and concerns of using telehealth.
The purpose of telemedicine is to remove distance as a barrier to health care. While telehealth is an accepted resource to bridge the gap between local and global health care, integrating telehealth into existing health infrastructures presents a challenge for both governments and policy makers (HRSA, 2011). Today there are policy barriers that prevent the expansion of telehealth, including reimbursement issues raised by Medicare and private payers, state licensure, and liability and privacy concerns.
Cerebrovascular disease or the term stroke is used to describe the effects of an interruption of the blood supply to a localised area of the brain. It is characterized by rapid focal or global impairment of cerebral function lasting more than 24 hours or leading to death (Hatano, 1976). As such it is a clinically defined syndrome and should not be regarded as a single disease. Stroke affects 174-216 people per 10,000 population in the UK per year and accounts for 11% of all deaths in England and Wales (Mant et al, 2004). The risk of recurrent stroke within 5 years is between 30-43%. One problem is that the incidence of stroke rises steeply with age and the number of elderly people in the UK is on the increase. To date people who experience a stroke occupy around 20 per cent of all acute hospital beds and 25 per cent of long term beds (Stroke Association, 2004). The British Government now identifies stroke as a major economic burden on the National Health Service (DoH, 2002).
Panagos, P. (2008). The approach to optimising stroke care. The American Journal of Emergency Medicine, 26, 808−816. doi:10.1016/j.aejm.2007.11.014
Among the main aims of health care reform and improvement is expanding healthcare access to different populations, which have been subjects to underserving for a long period. These include the poor, the previously uncovered, rural societies, and the minorities, to mention just a few. Great challenges definitely lie ahead, since several individuals start seeking access to the primary healthcare clinicians (Arnaert & Delesie, 2001). Telenursing assures to be a crucial tool to meet such needs. It refers to making use of the telehealth technology in conducting nursing practice and delivering nursing care. Because of the quick telemedicine technology adoption within the healthcare institutions, telenursing emerges as a fresh tool that provokes discussions
Telehealth definition according to our textbook by Hebda, T., & Czar, P., 2013 is the use of telecommunications technologies and electronic information to exchange healthcare information and to provide and support services such as long-distance clinical healthcare to clients. It provides health care to patients that may not be able to have access to care. Telehealth requires a patient to have electronic tools to facilitate this type of service. Electronic tools can be a telephone, computer, or a video camera. The patient is able to call or enable video conferencing to have access to their health care provider. Telehealth allows the patient to have access to preventative care and education on their disease process and how to manage it at home.
Strokes are the most common cause of disability and leading cause of death in the United States. Estimates of the number of stroke survivors in the United States exceed 3 million, and nearly 150,000 Americans died from stroke in 1995. The frequency with which strokes occur and the devastating effects they can have on survivors and their families make provision of general information about prevention and management an essential element of public health education. Previous researchers have found that between 14% and 40% of adults cannot name a single risk factor associated with stroke. This is reason for concern among the medical community.
Telemedicine is a new comer to the field of medicine and it is the treatment of patients by means of telecommunications technology. Telemedicine is carried out in a variety of ways whether it is by smart phone, wireless tools or other forms of telecommunications. Examples of telemedicine include: 1) transmission of medical images 2) care services at the home of the patient 3) Diagnosis at distance 4) education and training of patients. The diversity of practices in what is known as telemedicine raises many questions and one of those questions, which is extremely important, relate to the safety of the practice and the risks involved.
In summary, Hospital A will implement a new process for responding to in-hospital stroke calls. This new process will improve quality outcomes of patients experiencing in-hospital strokes. There are no additional costs involved in implementing this process. Data will be collected and reported for stroke measures previously outlined. Through researching this project, additional educational opportunities were identified. Hospital A will further explore these opportunities in the future.
“Time is brain” is the repeated catch phrase when addressing the treatment and management of stroke (Saver, 2006). Access to prompt and appropriate medical care during the first few hours of stroke onset is critical to patient survival and outcomes. Recent changes in the guidelines for acute stroke care released by the American Heart Association (AHA) and the American Stroke Association (ASA) have improved patient access to treatment. Stroke treatment now follows the model of myocardial infarction treatment. Hospitals are categorized into four levels based on stroke treatment capability. The most specialized treatment is available in comprehensive stroke centers followed by primary stroke centers, acute stroke-ready hospitals, and community hospitals. The use of telemedicine now enables even community hospitals, with limited specialized capabilities, to care for stroke patients. Telemedicine puts emergency hospital personnel in contact with neurologists providing expertise in the evaluation of a stroke patient and determination of their eligibility for treatment with thrombolytic medication (Jefferey, 2013).
Imagine the ability to obtain healthcare services from almost anywhere in the world where you have access to a phone or computer. Now, imagine being able to provide nursing assessments, diagnosis, treatments, and recommendations to your patients from your home to almost anywhere in the world. Lauren Stokowski (2008) noted in her article that one fourth of the United States has rural residents. That number may appear small in comparison to the urban residences; however, rural residents have a tendency to to have “higher poverty rates, larger percentage of elderly, and tend to be in poorer health”. Could telenursing be a solution?