One of the biggest issues in stroke care is how to help patients in "neurologically underserved" hospitals-- places that either don't have access to a specialist, or where a specialist isn't always available to help in the emergency department. (A situation, btw, which can occur in urban hospitals as well as those in rural areas.) Telemedicine (consultation with stroke experts via audio and video feeds) and "drip and ship" (transferring patients to regional stroke centers after they get tPA) are two increasingly common ways to deal with the issue. And both got a vote of confidence in new studies presented at Stroke '09.
Catalina Ionita, MD, University at Buffalo Neurosurgery, Inc., compared outcomes of thrombolyzed stroke patients at a telemedicine "hub" hospital (Millard Fillmore Gates Hospital in Buffalo, NY), with those of the 10 "spoke" hospitals it served. While there were some differences in terms of length of stay and stroke severity, the clinical outcomes were basically the same for patients treated at both-- suggesting that access to a top-notch stroke team via telemedicine is essentially as good as being seen by one personally.
A second study gave a boost to the growing practice of "drip and ship", whereby patients get tPA treatment at a community hospital, and are then transferred to a regional stroke center for follow-up care. Outcomes were similar for patients given tPA at community hospitals and then transferred, vs. those given tPA at the regional stroke center from the start. That's good news, since the alternative to drip and ship is to immediately transfer a community hospital patient to a regional center for tPA, which can be problematic given the 3-hour window for administering the treatment.