Teleictus Aragón interconsultation videoconference platform
About this good practice
Stroke guidelines recommend a pre-treatment assessment time of < 90 minutes to improve the 3-month prognosis (OR 2.8). Reperfusion therapy (RT) should be applied if stroke/imaging experts diagnose and assess the cranial CT scan. Peripheral hospitals in Aragon (PH) lack on-call neurologists/radiologists, needing travel to the central hospital (CH), (usually > 90 minutes away).
A telemedicine platform was developed for videoconferencing (VC) & sharing documentation and radiological imaging to assess the patient with suspected stroke. There is a neurovascular neurologist consultant (NVC) on call at the CH every day (24/7) and a neurointerventional (NI) team on call.
We have 2 circuits based on the patient's location: Peripheral Hospital (PH): The emergency physician (EF) conducts a video consultation (VC) with the neurologist via telemedicine (NVC) in the central hospital (CH). The NVC interviews the patient and collaborates with the EF. They evaluate Thrombectomy (TBM) criteria. If the patient meets the criteria, they refer them to the CH immediately. If not, they assess RT criteria to start RT with IV-RTPA in the PH under the NVC's online supervision. Home: The clinician calls the out-of-hospital emergency physician (061), who contacts the NVC for a joint assessment. If TBM is indicated, they notify the emergency department of the CH to proceed with the NI procedure on the patient's arrival. If not indicated, the patient is referred to the nearest PH to start RT with IV-RTPA.
Expert opinion
Resources needed
Telecollaboration module in EHR: €30,000
Computers & cameras/9 hospitals: €9,000
Initial, videoconferencing (VC): €24,000
Current, VC: €30,000
Tablets/specific hospitals: €500
Maintenance: IT staff (in-house or external)
Total cost: €100,000 + on-call Vascular Neurology & Interventional Radiology
Evidence of success
All the population has access to a Stroke Ready hospital within 1 hour. Since 2012, treatments have increased, with RT ranging from 218-286 & thrombectomy from 126-177. Our mortality goal of <5% has been met since 2015, with rates below 2% in 2022-2023. The percentage change from 2022 compared to 2013 was -23% in men and -27% in women. Symptomatic haemorrhage rates remain stable (5-8%), with greater variability in asymptomatic cases; increased to 20% during the pandemic; since 2022 back to 5%.
Potential for learning or transfer
Aragon has 1,321,000 residents, with half in rural areas (high population dispersion). The use of the "Teleictus" teleconsultation modality, which integrates access to videoconferencing (with a camera for real-time examination), a DICOM neuroimaging repository (multimodal computed tomography), and written interconsultation on a secure access web, has proven to be a useful tool for evaluating and selecting cases for reperfusion treatment (fibrinolysis and thrombectomy) in hyperacute stroke in our region. It enables safe, equitable, and sustainable care. Over the years, monitoring indicators of treatment access, safety (haemorrhages, mortality), costs, and outcomes (treated patients, independent patients at three months) support its use in other European regions with low population density, transportation challenges, or limited availability of specialists (neurologists, radiologists, interventionalists) where centralizing services is necessary.