Objectives:To evaluate the impact of the Victorian Stroke Telemedicine (VST) program during its first 12 months on the quality of care provided to patients presenting with suspected stroke to hospitals in regional Victoria.Design: Historical controlled cohort study comparing outcomes during a 12-month control period with those for the initial 12 months of full implementation of the VST program at each hospital.Participants: Adult patients with suspected stroke presenting to the emergency departments of the participating hospitals. Main outcome measures:Indicators for key processes of care, including symptom onset-to-arrival, door-to-first medical review, and door-to-CT times; provision and timeliness of provision of thrombolysis to patients with ischaemic stroke.Results: 2887 patients with suspected stroke presented to participating emergency departments during the control period, 3178 during the intervention period; the patient characteristics were similar for both periods. A slightly larger proportion of patients with ischaemic stroke who arrived within 4.5 hours of symptom onset received thrombolysis during the intervention than during the control period (37% v 30%). Door-to-C T scan time (median, 25 min [IQR, 13-49 min] v 34 min [IQR, 18-76 min]) and door-to-needle time for stroke thrombolysis (73 min [IQR, 56-96 min] v 102 min [IQR, 77-128 min]) were shorter during the intervention. The proportions of patients who received thrombolysis and had a symptomatic intracerebral haemorrhage (4% v 16%) or died in hospital (6% v 20%) were smaller during the intervention period.Conclusions: Telemedicine has provided Victorian regional hospitals access to expert care for emergency department patients with suspected acute stroke. Eligible patients with ischaemic stroke are now receiving stroke thrombolysis more quickly and safely.The known: Telemedicine support has improved access to acute stroke therapies in regional hospitals overseas, but has not been provided on a large scale in Australia.The new: The Victorian Stroke Telemedicine (VST) program in 16 hospitals in regional Victoria was associated with improved delivery of acute stroke therapies, including providing thrombolysis more quickly and safely. The implications:The VST program has improved access to stroke specialists in regional Victoria and the quality of care for people with acute stroke. The program is now fully funded by the Victorian government.

Purpose: Technology-based systems like telemedicine are frequently being implemented into healthcare settings, impacting clinician practices. Little is known about factors influencing acute telemedicine uptake, if factors differ across time, or between nurses and non-nurses. Design: A mixed-methods, pre-post design with implementation of a new acute stroke telemedicine service. Methods: A survey based on an extended Technology Acceptance Model (TAM) was administered to clinicians involved in acute stroke care at 16 regional hospitals (2014-2017). Open-ended questions postimplementation (at 6 months) included strengths of the program and areas to improve. Subsequently, a secondary analysis of nurses' semistructured interviews at the first telemedicine site (2010-2011) was completed to provide greater explanatory detail. Findings: Surveys were completed by nurses (preimplementation n = 77, postimplementation n = 92) and non-nurses (pre n = 90, post n = 44). Preimplementation, perceived usefulness was the only significant predictor of intending to use telemedicine for nurses, while perceived ease of use and social influence were significant for non-nurses. Postimplementation, perceived usefulness was significant for both groups, as was facilitating conditions for nurses. Specific examples aligned to TAM categories from our detailed interviews (n = 11 nurses) included perceived usefulness (improved clinical support and patient care), perceived ease of use (technical, clinical aspects), facilitating conditions (setting, education, confidence), and social influence (working relationships). Conclusions: Important factors for acute stroke telemedicine varied between nurses and non-nurses, and changed after implementation. The benefits of telemedicine should be emphasized to nurses. Preimplementation, more non-nurses wanted systems to be easy. Support in clinical, technical, and relationship aspects of telemedicine consultations is required. Clinical Relevance: Nurses are influential in implementing acute telemedicine, which is complex, with clinical and technical aspects entwined. Evidence-based implementation strategies must be tailored over time, and between nurses and non-nurses, to ensure initial uptake and ongoing use.

ObjectiveTo compare the processes and outcomes of care in patients who had a stroke treated in urban versus rural hospitals in Australia.DesignObservational study using data from a multicentre national registry.SettingData from 50 acute care hospitals in Australia (25 urban, 25 rural) which participated in the Australian Stroke Clinical Registry during the period 2010–2015.ParticipantsPatients were divided into two groups (urban, rural) according to the Australian Standard Geographical Classification Remoteness Area classification. Data pertaining to 28 115 patients who had a stroke were analysed, of whom 8159 (29%) were admitted to hospitals located within rural areas.Primary and secondary outcome measuresRegional differences in processes of care (admission to a stroke unit, thrombolysis for ischaemic stroke, discharge on antihypertensive medication and provision of a care plan), and survival analyses up to 180 days and health-related quality of life at 90–180 days.ResultsCompared with those admitted to urban hospitals, patients in rural hospitals less often received thrombolysis (urban 12.7% vs rural 7.5%, p<0.001) or received treatment in stroke units (urban 82.2% vs rural 76.5%, p<0.001), and fewer were discharged with a care plan (urban 61.3% vs rural 44.7%, p<0.001). No significant differences were found in terms of survival or overall self-reported quality of life.ConclusionsRural access to recommended components of acute stroke care was comparatively poorer; however, this did not appear to impact health outcomes at approximately 6 months.

Objective The aim of this study was to understand clinicians’ experiences of teleneuropsychology service implementation within rural inpatient rehabilitation settings and the variability of those experiences across rural settings and clinical disciplines. Method Clinicians (n = 56 from four rehabilitation settings) who were involved in a hub-and-spoke teleneuropsychology service completed surveys throughout service implementation. A purposive sample of 16 clinicians then completed semi-structured interviews at the conclusion of the service implementation period. Quantitative data were analyzed descriptively and qualitative data were analyzed using thematic analysis, prior to the results being converged. Results Four themes characterizing clinicians’ experiences were identified. Pre- and early-implementation considerations included factors such as early collaboration and consultation, which were identified as important for service integration into rural settings. Facilitators/barriers included factors such as technology usability, which positively or negatively influenced service implementation. Benefits and outcomes included perceptions on the impact of the service, such as improved equity and quality of care in rural settings. Finally, future applications encapsulated what the clinicians envisaged for the future of teleneuropsychology services, such as hybrid teleneuropsychology/in-person services. Some differences were identified in clinicians’ experiences across rural settings and disciplines, including preferences for technology infrastructure and satisfaction with teleneuropsychology sessions. Conclusions Most clinicians reported positive experiences and acceptability of the teleneuropsychology service. Facilitators and barriers, which can guide the successful establishment of future teleneuropsychology services, were identified. These findings may be used to contribute to improving equity and quality of care for people living with neuropsychological impairments, especially those living in rural areas.