Telestroke & Remote Care Flashcards

A remote neurologist reviewing a CT scan via telestroke notices early ischemic changes involving more than one-third of the MCA territory. What is the appropriate recommendation?

Answer: Withhold tPA due to increased hemorrhagic transformation risk in large territory infarct

Early ischemic changes affecting more than one-third of the MCA territory are associated with high hemorrhagic transformation risk and are a relative contraindication to tPA.

Which telestroke program characteristic is most associated with sustained long-term success according to implementation research?

Answer: Strong institutional commitment, dedicated program coordination, and continuous quality improvement processes

Sustained telestroke success depends on organizational commitment, dedicated coordination, and ongoing QI rather than technology alone.

A 68-year-old patient with atrial fibrillation on warfarin presents with acute stroke symptoms. The telestroke neurologist reviews labs showing INR of 2.8. What is the implication for tPA eligibility?

Answer: tPA is contraindicated because INR above 1.7 is an exclusion criterion

AHA/ASA guidelines exclude patients on warfarin with INR greater than 1.7 from IV tPA due to elevated hemorrhagic risk.

What role does the Advanced Stroke Coordinator play when a telestroke consult results in a recommendation for mechanical thrombectomy?

Answer: Coordinate urgent transfer to a thrombectomy-capable center while maintaining communication with the receiving team

The stroke coordinator facilitates rapid, seamless transfer to a thrombectomy-capable facility while ensuring communication continuity between teams.

Which statement best describes 'asynchronous telestroke' (store-and-forward)?

Answer: A neurologist reviews pre-recorded patient data and images and responds within a defined timeframe

Asynchronous (store-and-forward) telestroke involves reviewing pre-recorded clinical data and images without a live connection, suitable for non-emergency neurology consultations.

A spoke hospital's telestroke data shows that tPA is being administered at an average of 78 minutes door-to-needle. Which specific process step most commonly causes delays in telestroke DTN time?

Answer: Delay between CT scan completion and telestroke neurologist notification

Delays in notifying the telestroke neurologist after CT completion are a frequently identified bottleneck in reducing door-to-needle times.

Under HIPAA, which safeguard is MOST critical when transmitting patient imaging and clinical data during a telestroke consultation?

Answer: End-to-end encryption of all data transmitted over the telemedicine platform

HIPAA requires end-to-end encryption to protect the confidentiality and integrity of protected health information during electronic transmission.