Telestroke’s Role Through the COVID-19 Pandemic and Beyond

Abstract

Purpose of review The goal of this paper is to discuss the role and utilization of telestroke services through the COVID-19 pandemic and to suggest future directions to sustain and increase patients' access to stroke expertise. Recent findings Telestroke is an innovative and effective tool that has been shown to improve access, quality of care, and outcomes of patients with acute stroke syndromes in resource-limited areas for the last two decades. The COVID-19 pandemic posed a significant challenge and strained healthcare systems worldwide, but it created novel and unique opportunities to expand and increase the utilization of telehealth and telestroke services to deliver personalized healthcare across the continuum of stroke care outside of traditional settings. This rapid and widespread increase in telestroke use was facilitated by the removal of many legislative and regulatory barriers which have limited patients' access to stroke expertise for many years. Summary As the public health emergency ends, there exists a unique opportunity to optimize and expand upon the pandemic-related rapid growth of telestroke care. Optimal utilization of telehealth and telestroke services will depend on maintaining and improving required infrastructure, laws, and regulations, particularly those governing reimbursement and licensing.

Telehealth and Technology

“…Many cancer-directed interventions require in-person presence and cannot be replaced by telehealth models. For example, surgical and other procedures, chemotherapy and blood product administrations, delivery of radioactive photons/protons, imaging services, and phlebotomy cannot be conducted remotely or without adequate onsite personnel, although such care may be directed remotely, as with telestroke medicine 26–30 . Other aspects of cancer care are amenable to telehealth augmentation.…”

“…For example, surgical and other procedures, chemotherapy and blood product administrations, delivery of radioactive photons/protons, imaging services, and phlebotomy cannot be conducted remotely or without adequate onsite personnel, although such care may be directed remotely, as with telestroke medicine. [26][27][28][29][30] Other aspects of cancer care are amenable to telehealth augmentation. These generally include scenarios where self-administration is a major component of cancer treatment and supportive oncology.…”

Telerehabilitation service impact on physical function and adherence compared to face‐to‐face rehabilitation in patients with stroke: A systematic review and meta‐analysis

“…Face‐to‐face physical therapy services can be provided directly to patients in the home environment, whereas telerehabilitation enables delivery of rehabilitation by therapists to a patient's home from a remote location. Although the COVID‐19 pandemic strained health care systems globally, novel opportunities arose to expand and increase the use of in‐home stroke services such as therapy to provide personalized care across the stroke continuum 5,6 . Exercise protocols and various functional assessment tools for individuals were administered without standardization of approaches 7 .…”

Implementing Telestroke in the Inpatient Setting: Identifying Factors for Success

“…12 These compelling logistical reasons have driven the expansion of comprehensive inpatient telestroke programs (and other subspecialized branches of inpatient medicine). 11,13 However, the implementation of such programs has yet to be rigorously studied. There is a profound research-to-practice gap in health care with only about 1 in 5 evidence-based interventions making it into routine clinical care.…”