1. Needs Assessment

2. System Development

3. Clinical and Operational Implementation

4. Training

5. Evaluation

Case Study

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Standardised Telemedicine Toolkit for Stroke


This toolkit originated from work undertaken on a UK National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) project called ASTUTE (Acute Stroke Telemedicine: Utility, Training and Evaluation). The aim was to create a resource to support the implementation of telestroke. The resulting Standardised Telestroke Toolkit is in five sections (needs assessment, telestroke system development, telestroke system clinical and operational implementation, training, evaluation). Each section has information from:

Implementation tasks

Lessons learned

1.1  Develop a business case for telestroke

Procuring a telemedicine system

1.2  Develop a service and system specificiation for telestroke


1.3  Involve key individuals in the telemedicine implementation

Developing consensus for telemedicine in stroke

1.4  Formalise communication and agreement for telemedicine implementation

Developing communication routes for telemedicine in stroke
Getting agreement for telemedicine in stroke
Agreeing the finances for telemedicine in stroke

2.1  Develop governance procedures and funding agreements for telestroke

Developing governance procedures for telestroke

2.2  Developing shared clinical resources for telestroke

Developing shared clinical resources for telestroke

2.3  Develop and test the telestroke system

Job planning issues and staffing resources for telestroke
Developing a workable rota for telestroke
Testing the telemedicine equipment and the system

3.1  Develop clinical procedures for telestroke

Where should thrombolysis and post-thrombolysis monitoring take place?
Who should do next day scans and reviews?
Communicating the telestroke clinical decision securely

3.2  Develop operational and technical procedures for telestroke

When should decision-support providers be contacted in out-of-hours situations?
Going live with the rota and the telemedicine system

3.3  Develop guidance for patient involvement for telestroke Ensuring patient privacy and dignity during a telestroke consultation
4.1  Clinical training for telestroke

Who should do patient referral assessment?
Who should assess competence for telestroke?
Building confidence and expertise in telestroke

4.2  Wider training and updating 

Training provision and updating
Cultural issues between disciplines
Cultural issues raised by audio-visual communication

5.1 Monitor clinical processes and outcomes of telestroke

Ongoing multidisciplinary review of telestroke consultations
Data recording of the telestroke consultation

5.2 Monitor telestroke system use and impact on decision making Information about telestroke that was not being collected
5.3 Monitor fidelity, quality, and acceptability Difficulty of measuring patient satisfaction of the telestroke experience

5.4 System sustainability, expansion, modification