1. Telestroke: An Overview March 2013

2. 2 What is telestroke? Telestroke is an emergency telemedicine application It allows for the assessment & treatment of patients experiencing acute ischemic stroke via a consult with a remote neurologist. Referring telestroke sites are those that don’t have an on-site neurologist but do have a CT scanner, telemedicine network infrastructure, telemedicine equipment and protocols. Consulting sites are where participating neurologists can review the results of a patient’s CT scan electronically & “see” a patient at a remote site using live video.

3. 3 Statistics Telestroke began in North Bay in 2002 Between July 2002 and February 2013, 2998 consults were provided to Ontario stroke patients by telestroke physicians Over 900 patients have received tPA (~30%) as a result of a telestroke consult Averaging 50 telestroke calls/month with 21 referring sites

4. 4 Who is currently involved? 21 referring sites Ajax, Barrie, Belleville, Brantford, Cornwell, Dryden, Fort Frances, Goderich, Hawkesbury, Kenora, New Liskeard, Niagara, North Bay, Oshawa, Pembroke, Peterborough, Sault Ste. Marie, Scarborough, Sioux Lookout, Sudbury, Timmins, 11 DSCs & 10 non-DSCs 10 provincial consulting neurologists Toronto, Ottawa, Huntsville, Hamilton

5. 5 The telestroke program… provides a 24/7 emergency service that receives 24/7 technical support from OTN for telemedicine equipment; uses CritiCall to contact a telestroke neurologist using a single on-call system; provides equipment and supports neurologists in their homes for 24/7 coverage; supports discussions between referring and consulting physicians regarding the delivery of tPA; makes CT imaging available to the neurologist; and provides access to neurologists for 24-hour follow- up, if required.

6. 6 Overall Telestroke Clinical Process Flow

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8. 8 Technology & Support Videoconferencing units – in EDs (Tandberg Interns), desk top home based units for neurologists CT image access –ENITS 24/7 OTN service desk to support videoconferencing & image access

9. 9 Becoming a telestroke site… The application process is under review – but the process will include: –Working with your Regional Stroke Centre & OTN to complete an application –Applicants will be assessed based on eligibility, readiness and need

10. 10 Approval & Next Steps Approval received Protocols to be finalized & implemented Any clinical training of front line staff to be set up with Regional Stroke Centre OTN to facilitate equipment deployment, installation, certification & testing OTN to provide technical training Mock sessions scheduled & completed Go live date set

11. Roles & Responsibilities OTNOSNReferring Site Will provide technical & operational support for implementation Will provide ongoing 24/7 technical support Endorsement of site to be a referring site Support for referring site re. training & development of clinical protocols Work re. bypass protocols Provide video equipment Network drop installation CT configuration for ENITS Training hours for staff (clinical & technical) Clinical protocol development Patient registration/billing information to consulting site Treatment of patients

13. 13 Key Contact Information Jennifer Mills Beaton, Emergency Services Manager, jmillsbeaton@otn.ca or 519-931-4400 x4452.jmillsbeaton@otn.ca Dr. Frank L. Silver, Medical Director Telestroke, frank.silver@uhn.on.ca or 416-603-5416. frank.silver@uhn.on.ca