Considerations for the Implementation of a Telestroke Network: A Systematic Review

Area of Science:

• Neurology
• Health Services Research
• Telemedicine

Background:

• Telestroke services, established in 1999, are now guideline-recommended.
• Previous reviews focused on implementation challenges up to 2010.
• Significant expansion of telestroke services necessitates updated implementation guidance.

Purpose of the Study:

• To systematically review factors for successful establishment, management, and sustainability of contemporary telestroke services.
• To provide practical information for implementing telestroke in new jurisdictions.
• To identify barriers and recommendations for telestroke network implementation.

Main Methods:

• Systematic review of empirical studies published between 2010 and 2021.
• Inclusion of studies with descriptive, evaluation, or operational data on telestroke network implementation.
• Evaluation of included studies using the Consolidated Framework for Implementation Research (CFIR).

Main Results:

• 38 studies met inclusion criteria from an initial search of 7415 potential studies.
• Pre-implementation planning is critical for clear processes, governance, and stakeholder engagement.
• Sustainability hinges on long-term investment, adequate resources, and motivated staff.

Conclusions:

• Contemporary telestroke implementation requires nuanced understanding of process evaluations.
• Recommendations address technology, staffing, planning, standardization, evaluation, and scale-up barriers.
• Future research should integrate advanced stroke care like EVT and imaging into telestroke planning.