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Telestroke is Transforming Emergency Stroke Care

By: | Tags: , , , , , | May 13th, 2025

By Dr. Rob Malka

Patients who suffer a stroke are in a race against time. The symptoms occur suddenly, often without warning, and the likelihood of death or permanent disability increases with each passing minute that brain cells are deprived of blood flow. According to the American Stroke Association, stroke remains the fifth leading cause of death and a leading cause of disability in the United States. However, timely treatments such as the administration of “clot-busting” (thrombolytic) medications, and in some cases direct clot removal (endovascular intervention), have been proven to dramatically reduce the risk of death and permanent disability. For these treatments to be effective, hospitals and emergency departments require ultra-fast access to stroke experts who can make an accurate diagnosis and safely implement appropriate management as quickly as possible. In the past, such experts were only available in larger and academic medical centers. However, telestroke is transforming emergency stroke care by providing rapid, 24/7 access to stroke neurologists, even for patients in remote locations or hospitals that do not have access to on-site stroke specialists.

Telestroke availability facilitates rapid diagnosis and treatment. Using high-quality audio/video conferencing technology, neurologists with expertise in the diagnosis and management of stroke can be on-screen at the patient’s bedside within minutes. This is essential for emergency treatment to restore circulation to the brain, as millions of neurons and neuronal connections are lost with each minute that blood flow is impaired. Treatments for acute stroke are most effective at restoring circulation and improving patient outcomes the sooner they are administered. The telestroke neurologist on video can rapidly assess the patient on camera and communicate directly with the patient and family, as well as directly view imaging studies and other patient data in the electronic medical record. This allows for extremely fast response times and comprehensive medical decision-making. Studies show telestroke care can increase the number of patients who receive timely treatment, as well as decrease long-term disability, with a similar impact as an on-site neurologist.1,2

Telestroke programs also provide access to specialized care to a far broader population than is possible with traditional in-person models. Neurologists with expertise in stroke are in short supply, usually staffing hospitals in bigger cities and academic centers. However, strokes affect patients everywhere, including in locations far from such facilities. Telestroke levels the playing field by allowing rapid access to a stroke neurologist anywhere at any time. This improves outcomes and reduces disparity for stroke patients in rural areas who would not otherwise have timely access to such a specialist.3 Facilities that do have on-site neurologists also benefit from integrating telestroke into their coverage, reducing the on-call burden and excessive workloads for those on-site specialists, especially during nights and weekends.

In addition to ensuring 24/7 access to expert stroke care for patients, telestroke neurologist availability helps local healthcare providers, including nurses and paramedics, receive real-time guidance and education during consults. This helps in building the local knowledge base and community awareness for better stroke recognition and pre-hospital care, as well as emergency management.4

In extension of the above, telestroke integration helps to streamline patient care in existing stroke networks with a “hub-and-spoke” model. Patients who live far from a large comprehensive stroke center (the “hub”) often have closer proximity and thus faster access to a smaller local hospital (the “spoke”) where the patient can undergo initial evaluation and treatment. Aside from timely diagnosis and thrombolytic therapy, the telestroke neurologist can provide expert decision support regarding the possible need for transfer to the comprehensive center for endovascular therapy and/or specialized intensive care monitoring. They can even communicate directly with the team at the comprehensive center and provide integral patient data so that the receiving team is immediately ready to proceed upon the patient’s arrival. This paradigm optimizes not only treatment rates and door-to-needle times5 but also patient triage and transfer utilization, reducing the overall cost and efficiency of care.6

Telestroke services have a substantive impact on the management and outcomes of stroke patients, who require emergent access to specialized care and expertise. Telestroke has transformed the landscape of emergency stroke care, providing far-reaching access to rapid and safe diagnosis and treatment, improving timeliness of care, and helping hospitals in all types of communities implement integrated, streamlined, and comprehensive stroke care.

References:

  1. Nguyen-Huynh MN, Klingman JG, Avins AL, Rao VA, Eaton A, Bhopale S, Kim AC, Morehouse JW, Flint AC; KPNC Stroke FORCE Team. Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System. Stroke. 2018 Jan;49(1):133-139. doi: 10.1161/STROKEAHA.117.018413. Epub 2017 Dec 15. PMID: 29247142; PMCID: PMC5753819.
  2. Massaud RM, Accorsi TAD, Massant CG, Silva GS, de Carvalho Leite AV, Franken M, Moreira FT, Köhler KF, De Amicis Lima K, Morbeck RA, Pedrotti CHS. In-hospital stroke protocol outcomes before and after the implementation of neurological assessments by telemedicine: an observational case-control study. Front Neurol. 2024 Mar 5;15:1303995. doi: 10.3389/fneur.2024.1303995. PMID: 38504799; PMCID: PMC10948599.
  3. Kulcsar M, Gilchrist S, George MG. Improving stroke outcomes in rural areas through telestroke programs: an examination of barriers, facilitators, and state policies. Telemed J E Health. 2014 Jan;20(1):3-10. doi: 10.1089/tmj.2013.0048. Epub 2013 Nov 28. PMID: 24286197.
  4. Lazarus G, Permana AP, Nugroho SW, Audrey J, Wijaya DN, Widyahening IS. Telestroke strategies to enhance acute stroke management in rural settings: A systematic review and meta-analysis. Brain Behav. 2020 Oct;10(10):e01787. doi: 10.1002/brb3.1787. Epub 2020 Aug 18. PMID: 32812380; PMCID: PMC7559631.
  5. Sharma R, Zachrison KS, Viswanathan A, Matiello M, Estrada J, Anderson CD, Etherton M, Silverman S, Rost NS, Feske SK, Schwamm LH. Trends in Telestroke Care Delivery: A 15-Year Experience of an Academic Hub and Its Network of Spokes. Circ Cardiovasc Qual Outcomes. 2020 Mar;13(3):e005903. doi: 10.1161/CIRCOUTCOMES.119.005903. Epub 2020 Mar 4. PMID: 32126805; PMCID: PMC7374496.
  6. Switzer JA, Demaerschalk BM, Xie J, Fan L, Villa KF, Wu EQ. Cost-effectiveness of hub-and-spoke telestroke networks for the management of acute ischemic stroke from the hospitals’ perspectives. Circ Cardiovasc Qual Outcomes. 2013 Jan 1;6(1):18-26. doi: 10.1161/CIRCOUTCOMES.112.967125. Epub 2012 Dec 4. PMID: 23212458.

Nattasha Acevedo, MD

Dr. Acevedo received her medical degree from the Ponce School of Medicine in Puerto Rico and did her neurology residency at Montefiore Medical Center in New York. She went on to do a clinical neurophysiology fellowship at Emory School of Medicine in Atla nta, Georgia and then joined private practice in Fort Myers, Florida. She currently resides in San Juan, Puerto Rico. She likes running, paddle boarding and spending time with family.
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Bernadette Borte, MD

Dr. Borte received her medical degree from St. Matthew’s University School of Medicine in Grand Cayman. She completed her neurology residency at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. Her areas of interest include inpatient neurology and acute stroke. When not working, she enjoys spending time outdoors with her family. Dr. Borte joined the TeleSpecialist family in March of 2019.
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Mazen Almidani, MD

Dr. Almidani is board certified in pediatrics by the American Board of Pediatrics and board certified in epilepsy, as well as neurology with special  qualification in child neurology by the American Board of Psychiatry and Neurology.  Dr. Almidani is happily married with 4 children. His oldest son has autism and his daughter has complicated seizures; both were a drive for him to become a neurologist. Dr. Almidani enjoys soccer, running and spending time with his family. He is very involved with his sons’ therapy and helping with daily challenges. He is double board certified in Pediatric and Adult Neurology and Epilepsy. He sees children and adults. He also participates in charities for children in Syria who may be underprivileged and/or affected by the war. Dr. Almidani joined TeleSpecialists in August 2020.
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Amanda Cheshire, MD

Dr. Cheshire received her medical degree from the University of Louisville School of Medicine in Louisville, Kentucky. She completed her neurology residency at the University of Cincinnati Medical Center in Cincinnati, Ohio. She did a fellowship in neurophysiology at the University of Michigan Medical School in Ann Arbor, Michigan. Dr. Cheshire is double board certified in neurology and clinical neurophysiology. She enjoys traveling, reading and music. She currently resides in Viera, Florida.  Dr. Cheshire joined TeleSpecialists in June 2019.
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Jessica Floyd, MD

Dr. Floyd completed her neurology residency at Mayo Clinic in Jacksonville, Florida followed by fellowship training in clinical neurophysiology with focus in EEG and epilepsy at the Medical University of South Carolina in Charleston, South Carolina. She has particular interest in hospital neurology and patient education as well as the blossoming specialty of lifestyle medicine. She strives to take advantage of every encounter with patients and medical staff to empower them to do their own research into how daily thoughts, choices, and habits can add up to create greater and longer-lasting brain and neurologic health for ourselves and our loved ones. She lives in Florence, South Carolina with her awesome husband of 13 plus years and three beautiful children. She is an avid yogi, astrologer, and lover of food and all things neurology! Dr. Floyd joined the TeleSpecialist family in July 2017.
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Nancy Futrell, MD

Dr. Futrell received her medical degree from the University of Utah in Salt Lake City, Utah. She also did her neurology residency at the University of Utah as well as a research fellowship in cerebral vascular disease at Jackson Memorial Hospital in Miami, Florida. She currently resides in Salt Lake City, Utah. She has authored 2 books and 50 peer reviewed papers. 
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Rebecca Jimenez-Sanders, MD

Dr. Jimenez Sanders received her undergraduate degree from Emory University, and her medical degree from the San Juan Bautista School of Medicine in Puerto Rico. She completed her neurology residency at the University of South Florida in Tampa, Florida, where she also did a specialized headache medicine and facial pain fellowship. She currently resides in Tampa, Florida with her husband and her two daughters. She is also fluent in Spanish and Italian languages, and enjoys photography, baking, boating, and biking.
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Cory Lamar, MD

Dr. Lamar received his medical degree from Meharry Medical College in Nashville, Tennessee. He completed his internship and residency at Wake Forest Baptist Health in Winston Salem, North Carolina. Following residency, he completed a clinical fellowship in neurophysiology, with a concentration in epilepsy. He currently resides in Florida and enjoys outdoor activities.
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Clifford Meyers, MD

Dr. Meyers received his medical degree from Brown University in Providence, Rhode Island and his MBA from the Simon School of Business at the University of Rochester in Rochester, New York. He completed his neurology residency at the University of Rochester, where he also did a neurophysiology fellowship. Dr. Meyers resides in Webster, New York with his wife and daughter. When not doing teleneurology, he enjoys playing sports with his wife and daughter.
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Tao Tong, MD

Dr. Tong received her medical degree from the University of Miami School of Medicine in Miami, Florida. She completed her neurology residency at Jackson Memorial Hospital in Miami, Florida, where she also did a neuromuscular/EMG fellowship.  She currently resides in College Station, Texas. Dr. Tong is married with two boys. She enjoys spending time with her family, traveling and reading.
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Shubhangi Chumble, MD

Dr. Chumble attended BJ Medical School. She is a board certified neurologist with a subspeciality interest in sleep medicine. Dr. Chumble did her residency at Howard University in Washington DC and has practiced neurology since 2001 in private and corporate settings. She lives in Melbourne, Florida and loves the sunshine state. Her hobbies include yoga, meditation, cooking , traveling and meeting new people. She also loves to do stained glass, pottery and painting. She joined TeleSpecialists in June 2019.
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