ASC Telestroke & Remote Care 3 — Questions and Answers
Question 1: What regulatory body provides certification standards that directly influence telestroke program quality benchmarks in the United States?
- FDA
- The Joint Commission (TJC) (Correct answer)
- DEA
- CMS only, with no other oversight
Correct answer: The Joint Commission (TJC)
The Joint Commission's Primary and Comprehensive Stroke Center certification standards set quality benchmarks that telestroke programs must support.
Question 2: A patient with wake-up stroke presents at a spoke hospital. The telestroke neurologist wants to assess eligibility for late-window tPA using MRI DWI-FLAIR mismatch. What does this mismatch indicate?
- The stroke occurred more than 24 hours ago
- The ischemic core is older than the surrounding penumbra, suggesting stroke onset within approximately 4.5 hours (Correct answer)
- The patient has hemorrhagic transformation
- Large vessel occlusion is present
Correct answer: The ischemic core is older than the surrounding penumbra, suggesting stroke onset within approximately 4.5 hours
DWI-FLAIR mismatch (DWI positive, FLAIR negative) suggests the stroke occurred within approximately 4.5 hours, supporting tPA eligibility in wake-up stroke.
Question 3: Which of the following best describes the concept of 'telestroke as a hub-and-spoke model'?
- All patients are treated at a single central hospital
- A comprehensive stroke center provides remote neurological expertise to multiple smaller facilities (Correct answer)
- Spoke hospitals provide consultation to the hub
- Mobile stroke units replace the need for spoke hospitals
Correct answer: A comprehensive stroke center provides remote neurological expertise to multiple smaller facilities
In the hub-and-spoke model, a comprehensive stroke center (hub) extends expertise to community hospitals (spokes) via telemedicine.
Question 4: When documenting a telestroke encounter, which element is MOST critical to include for medicolegal and quality assurance purposes?
- The name of the telemedicine vendor
- Time stamps for consult initiation, NIHSS completion, imaging review, and treatment decision (Correct answer)
- The neurologist's home address
- Insurance information only
Correct answer: Time stamps for consult initiation, NIHSS completion, imaging review, and treatment decision
Accurate time stamps allow assessment of treatment delays, support regulatory compliance, and provide medicolegal documentation.
Question 5: A spoke hospital asks whether their telestroke neurologist can prescribe controlled substances for stroke-related pain remotely. Under the Ryan Haight Act, what is required?
- No restrictions apply in emergencies
- An in-person medical evaluation is required before prescribing controlled substances via telemedicine, with limited exceptions (Correct answer)
- Prescribing controlled substances via telemedicine is entirely prohibited
- Only the DEA can authorize remote prescriptions
Correct answer: An in-person medical evaluation is required before prescribing controlled substances via telemedicine, with limited exceptions
The Ryan Haight Act generally requires an in-person evaluation before prescribing controlled substances via telemedicine, though emergency exceptions exist.
Question 6: What is the recommended maximum door-to-needle time benchmark for IV tPA administration that telestroke programs aim to achieve?
- 30 minutes
- 45 minutes
- 60 minutes (Correct answer)
- 90 minutes
Correct answer: 60 minutes
The AHA/ASA benchmark for door-to-needle time is 60 minutes, with a target of achieving this in at least 50% of eligible patients.
Question 7: Which patient population benefits MOST from telestroke programs according to population-level outcome data?
- Urban patients near comprehensive stroke centers
- Rural patients who would otherwise have no access to acute stroke neurology expertise (Correct answer)
- Patients with transient ischemic attacks only
- Pediatric stroke patients exclusively
Correct answer: Rural patients who would otherwise have no access to acute stroke neurology expertise
Rural patients gain the greatest benefit from telestroke by accessing specialist care that would otherwise require transfer to distant facilities.
ASC Telestroke & Remote Care 3
What regulatory body provides certification standards that directly influence telestroke program quality benchmarks in the United States?