Background and Purpose-Because of a shortage of stroke specialists, many outlying or "spoke" hospitals initiate intravenous (IV) thrombolysis using telemedicine or telephone consultation before transferring patients to a regional stroke center (RSC) hub. We analyzed complications and outcomes of patients treated with IV tissue plasminogen activator (tPA) using the "drip and ship" approach compared to those treated directly at the RSC. Methods-A retrospective review of our Get With the Guidelines Stroke (GWTG-Stroke) database from 01/2003 to 03/2008 identified 296 patients who received IV tPA within 3 hours of symptom onset without catheter-based reperfusion. GWTG-Stroke definitions for symptomatic intracranial (sICH), systemic hemorrhage, discharge functional status, and destination were applied. Follow-up modified Rankin Score was recorded when available. Results-Of 296 patients, 181 (61.1%) had tPA infusion started at an outside spoke hospital (OSH) and 115 (38.9%) at the RSC hub. OSH patients were younger with fewer severe strokes than RSC patients. Patients treated based on telestroke were more frequently octogenarians than patients treated based on a telephone consult. Mortality, sICH, and functional outcomes were not different between OSH versus RSC and telephone versus telestroke patients. Among survivors, mean length of stay was shorter for OSH patients but discharge status was similar and 75% of patients walked independently at discharge. Conclusions-Outcomes in OSH "drip and ship" patients treated in a hub-and-spoke network were comparable to those treated directly at an RSC. These data suggest that "drip and ship" is a safe and effective method to shorten time to treatment with IV tPA. (Stroke. 2010;41:e18-e24.)Key Words: stroke Ⅲ telemedicine Ⅲ thrombolysis I ntravenous tissue plasminogen activator (IV tPA) is FDA approved for acute ischemic stroke (AIS) within the first 3 hours of symptom onset. 1 Previous studies have shown that IV tPA is underused and that only 3% to 4% of AIS patients receive thrombolytic treatment. 2 A majority of acute stroke patients present to hospitals that lack 24/7 availability of a stroke specialist, 3,4 are managed by generalists, 5 and many do not receive tPA at the presenting facility. 6,7 If practitioners opt for transfer to a regional stroke center (RSC) for initiation of tPA, delays may preclude delivery of tPA.Hub-and-spoke networks have been developed to allow IV tPA to be initiated at an outlying spoke hospital (OSH) under the supervision of a vascular neurologist at the designated RSC hub who provides assistance in the diagnosis and management of AIS via telephone 8 or telemedicine-enabled ("telestroke") 9 consultation before transfer. This practice has been referred to as "drip and ship." 10 The evidence supporting telemedicine for acute stroke care within a hub and spoke network has recently been reviewed and guideline recommendations published. 11,12 Limited data exist comparing the safety and feasibility of patients treated by "drip and ship" 13 versus patie...

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After completing this course, the reader will be able to:1. Carry out three communication tasks that improve the accuracy of interpretation and increase patient understanding.2. Provide recommendations for working collaboratively with medical interpreters.3. Overcome common sources of misunderstanding that result from language and cultural barriers.This article is available for continuing medical education credit at CME.TheOncologist.com. Professional medical interpreters play a crucial role in mediating language-discordant encounters between cancer patients and oncologists. Trained interpreters allow for timely information exchange that is both accurate and culturally sensitive. Rising numbers of immigrants will increase the demand for interpreters. Medical oncologists need to respond by establishing collaborative practices with interpreters or using remote interpretation services. The article provides specific recommendations for working with medical interpreters and reviews common areas of concern for patients and healthcare professionals facing language and cultural barriers. The Oncologist CME CME ABSTRACT

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