1. Needs Assessment

2. System Development

3. Clinical and Operational Implementation

4. Training

5. Evaluation

Case Study

Additional Resources



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Additional Resources

Section 1: Telestroke Needs Assessment

Normalisation Process Theory (NPT) Toolkit. The NPT toolkit is a resource to help you think through issues in the implementation of a new technology into health care.  It can be used at any stage of the process: from initially thinking through an idea, to understanding outcomes. However, it is probably most useful in the early stages to think about the implications of a new technology for the work of health care professionals.
Normalisation Process Toolkit

Section 2: Telestroke System Development

The Ontario Telemedicine Network's (OTN) eligibility screening checklist and the INTEGRIS TeleStroke Network's TeleStroke Application both ask useful questions to assess capacity before hospitals join an existing network.

OTN, Ontario, Canada. Two checklists are available: one to determine if eligibility requirements are met prior to initiating connection of a new site; and a second checklist to determine site readiness for implementation of telestroke. There is also a workflow for implementation at a new site and a detailed breakdown of every step of implementation.
OTN Eligibility Screening Checklist

Integris, Oklahoma, USA.  Integris use an implementation questionnaire that includes establishing a complete list of contacts in the new site; and establishing numerical data (e.g. patient throughput and geographical distances). They present a typical implementation schedule of approximately 12 weeks, highlighting the various meetings and agreements to be reached throughout the implementation processes, from mock consultation to official 'go-live'.
Integris Telehealth
Integris Telestroke

SIP Telestroke Governance Guidance 
SIP Telestroke Governance Guidance

NHS Medical Technology Adoption. NHS Institute for Innovation and Improvement (2009) Organisational and Behavioural Barriers to Medical Technology Adoption.
NHS Technology Adoption Centre

Section 3: Telestroke Clinical and Operational Implementation

Knapp P, Wanklyn P, Raynor DK, Waxman R (2010) Developing and testing a patient information booklet for thrombolysis used in acute stroke. International Journal of Pharmacy Practice. 18:  362-9

Other UK stroke telemedicine sites may also have useful documentation:

Avon, Gloucester and Wiltshire. Guidelines and Protocaols for Stroke.
Guidelines and protocols for stroke

Avon, Gloucester and Wiltshire. Also the Acute Ischaemic Stroke Thrombolysis Guideline.
Acute Ischaemic Stroke Thrombolysis Guideline

Ayrshire and Arran. Their Phase 2 Pilot Implementation of Thrombolysis for Acute Stroke document contains a lot of outlined clinical information.
Implementation of Thrombolysis for Acute Stroke

Dorset. Example of joint remote decision-making checklist from Dorset Stroke Network available as Appendix 4 of The Stroke Improvement Programme’s document Governance Issues for Telemedicine in Acute Stroke.
Governance Issues for Telemedicine in Acute Stroke

East of England. NHS East of England. (2010) Telemedicine for Stroke: An introduction to the service
Telemedicine for Stroke: An introduction

Fife. NHS Fife A & E Stroke Thrombolysis Protocol
Stroke Thrombolysis Protocol

Wales. Stroke/Thrombolysis Information Leaflet
Stroke/Thrombolysis Information Leaflet

Lanarkshire. Managed Clinical Network for Stroke: Stroke Unit Protocol/Guideline
Stroke Unit Protocol

Lanarkshire. NHS Lanarkshire Acute Operating Division. Lanarkshire Thrombolysis document
Lanarkshire Thrombolysis document

Lanarkshire. Managed Clinical Network for Stroke: Accident & Emergency Protocol
Accident & Emergency Protocol

Lothian. Lothian Stroke Managed Clincial Network: Pathways and Protocols available at
Pathways and Protocols

Lothian.Integrated Care Pathway for Thrombolysis for Stroke available at
Integrated Care Pathway for Thrombolysis for Stroke

Lothian. Their patient information leaflet for thrombolysis
Thrombolysis Patient Information

Northumbria. Stroke Northumbria’s A & E Stroke Thrombolysis Protocols
A & E Stroke Thrombolysis Protocols

Scottish Centre for Telehealth.
Scottish Centre for Telehealth

St. Thomas. Within the Stroke Improvement Programme’s document Governance Issues for Telemedicine in Acute Stroke:
Appendix 1 : Example of draft text for patient information
Appendix 2: Example of St Thomas’ Hospital’s Thrombolysis Assessment Process
Appendix 3: Example of instructions for the use of telemedicine equipment  from St Thomas’ Hospital
Governance Issues for Telemedicine in Acute Stroke

Yorkshire and Humber. Telehealth Toolkit.
Telehealth Toolkit

Section 4: Telestroke Training

University of Edinburgh - Telestroke Training and Certification.
Telestroke Training and Certification

Cumbria and Lancashire - The Stroke Network Training Resources
Stroke Network Training Resources

Video clips about ROSIER (Recognition Of Stroke In the Emergency Room)

NIHSS. NiH Stroke Scale
NiH Stroke Scale

Scottish Centre for Telehealth. Telestroke Training
Telestroke Training

East of England. Telemedicine for Stroke: an introduction to the Service.
Telemedicine for Stroke: an introduction to the Service

Educational Video. Activase (Alteplase) for the treatment of acute ischemic stroke
Activase for the treatment of acute ischemic stroke

STARS. Stroke Advancing Modules - Thrombolysis
Stroke Advancing Modules Thrombolysis

Thrombolysis Training Folder. from Stroke-in-Stoke
Thrombolysis Training Folder

 Essex Core Competencies For Stroke and Transient Ischaemic Attack
Stroke and TIA Competencies - see page 17

St George’s University of London – Thrombolysis Training Website
Introduction to Thrombolysis
Thrombolysis sitemap

Your Stroke. Core Information for those involved with stroke
Acute Stroke Care and Stroke Thrombolysis

StrokeEducation.co.uk. A resource for everyone involved in the management of stroke


Section 5: Telestroke Evaluation

BC Stroke Strategy (2008) Evaluation of Telemedicine for Stroke. Canada, British Columbia, H Kreuger & Associates.
Identifies the potential indicators recommended for use in evaluating a telestroke program from a review of the Indicators used for assessing telestroke in the literature.

Moskowitz A, Chan YY, Bruns J, Levine SR (2010) Emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke. 41: 805-9

Ekeland AG, Bowes A, Flottorp S (2011) Effectiveness of telemedicine: a systematic review of reviews. International Journal of Medical Informatics 2010, 79 (11):736-71.