The challenges of implementing a telestroke network: a systematic review and case study

Abstract

BackgroundThe use of telemedicine in acute stroke care can facilitate rapid access to treatment, but the work required to embed any new technology into routine practice is often hidden, and can be challenging. We aimed to collate recommendations and resources to support telestroke implementation.MethodsSystematic search of healthcare databases and the Internet to identify descriptions of the implementation of telestroke projects; interviews with key stakeholders during the development of one UK telestroke network. Supporting documentation from existing projects was analysed to construct a framework of implementation stages and tasks, and a toolkit of documents. Interviews and literature were analysed with other data sources using Normalisation Process Theory as described in the e-Health Implementation Toolkit.Results61 telestroke projects were identified and contacted. Twenty projects provided documents, 13 with published research detailing four stages of telestroke system development, implementation, use, and evaluation. Interviewees identified four main challenges: engaging and maintaining the commitment of a wide range of stakeholders across multiple organisations; addressing clinicians perceptions of evidence, workload, and payback; managing clinical and technical workability across diverse settings; and monitoring how the system is used and reconfigured by users.ConclusionsInformation to guide telestroke implementation is sparse, but available. By using multiple sources of data, sufficient information was collated to construct a web-based toolkit detailing implementation tasks, resources and challenges in the development of a telestroke system for assessment and thrombolysis delivery in acute care. The toolkit is freely available online.

‘It was like he was in the room with us’: patients’ and carers’ perspectives of telemedicine in acute stroke

“…It has been used in a number of studies, mainly in telecare and e‐health . NPT was used as an overall model to analyse the development and implementation of TM system in acute stroke from the differing perspectives of organizations, clinical staff and patients and carers . There has been little previous research which uses NPT to understand patients’ and carers’ views of new health‐care practices, and our study also explored the benefits and limitations of this method.…”

Monte Carlo Simulation Modeling of a Regional Stroke Team's Use of Telemedicine

“…While others have examined the effectiveness of telemedicine technology and the challenges in its implementation, and have offered recommendations on how to embed this technology into practice, 12–14 the regional differences in systems of stroke care suggest there is no prescriptive generalizable framework for designing a universal telestroke network. However, lessons may be gained from our system where we are able to model how best to care for all stroke patients within a population cared for by a single team of physicians.…”

Interventions interactives dans les médias sociaux visant à promouvoir l’équité en matière de santé : vue d’ensemble des examens

“…18,19 . Nous avons exclu aussi les applications de téléphone intelligent qui n'étaient pas munies d'une composante interactive avec les autres utilisateurs (comme une fonction de rétroaction ou de suivi du poids sur un téléphone intelligent à des fins d'utilisation personnelle seulement, sans réaction ou rétroaction de la part des autres utilisateurs et des pairs).…”