Telethrombolysis: when every minute counts

Telethrombolysis is a telehealth medical procedure that ensures equitable access to stroke treatment, regardless of the patient’s place of residence. It quickly connects a specialist neurologist in another hospital center with the local emergency care team. This ensures that the best possible decision is taken to limit the after-effects of the stroke.

Telehealth is more than just teleconsultation, during which a patient meets a healthcare professional at a distance. The telehealth modality also makes it possible to obtain, thanks to simple technologies, sometimes more complex health care and services.

How telethrombolysis works

Telethrombolysis is an example of how telehealth can play a key role in providing quality service in critical cases. Telethrombolysis is offered in hospitals that do not have the specialized resources and are too far away to transfer their patients in the time required.

How it works is quite simple: when a stroke patient arrives in the emergency department, the emergency physician calls the vascular neurologist on duty at the designated tertiary hospital. The on-call neurologist takes the call to discuss the clinical case, and prepares to accompany the emergency physician remotely to manage the patient. The patient’s clinical assessment is carried out via a live video call and by consulting results transmitted via a secure medical imaging system.

During his assessment, the neurologist confirms whether thrombolysis is the appropriate treatment, and if so, assists the emergency physician and his team in administering it. Depending on the case, a decision is made as to whether or not the patient needs to be transferred to a tertiary hospital.

A proven service

Telethrombolysis services are provided by vascular neurologists at two university hospitals:

• The Centre hospitalier de l’Université de Montréal (CHUM) serves some 15 hospital facilities in the Abitibi-Témiscamingue, Estrie, Lanaudière, Laurentides, Montérégie-Est and Outaouais regions.
• The CHU de Québec-Université Laval serves some twenty hospital facilities in Bas-Saint-Laurent, Capitale-Nationale, Côte-Nord, Gaspésie-Îles-de-la-Madeleine, Mauricie-Centre-du-Québec and Northern Québec.
• The Hôpital de Chicoutimi serves 3 hospital facilities in the Saguenay-Lac-Saint-Jean region.

Last year, 642 virtual consultations were carried out in the 38 or so emergency rooms benefiting from the service, resulting in more than 185 telethrombolyses. So many patients who might not have been able to obtain this treatment if they had had to be transferred to a hospital in an urban area.

This service has become essential for rural hospitals without a neurologist on staff. This is the case for the Centre multiservices de santé et de services sociaux du Haut-Saint-Maurice (La Tuque Hospital). Nurse clinician Dominique Richard is closely involved in organizing these interventions.

Telethrombolysis enables some twenty virtual consultations to be carried out each year in the La Tuque Hospital emergency department. This is all the more important for a primary hospital like ours, which serves the population of a large territory, and whose clientele includes a significant number of visitors to the region.

Dominique Richard

Assistant Head Nurse, Ambulatory, Critical Care and Emergency Services, CIUSSS de la Mauricie-et-du-Centre-du-Québec.

For equitable access to services

The Québec healthcare network is increasingly deploying initiatives based on information and communications technologies. These technologies, known as “telehealth”, are always used to complement conventional services. Care teams use telehealth to promote access to services and ensure an equitable level of care for all. Several projects and initiatives have already been the subject of articles right here on telesantequebec.ca. These include teledermatology, virtual mental health care, addiction medicine and youth health.

Telethrombolysis is part of a diversified range of services offered through the telehealth modality, enabling hundreds of stroke victims every year to receive optimal emergency care, regardless of where they live.

Watch Dr. Steve Verreault’s explanation in this short video from the Association des neurologues du Québec: La Téléthrombolyse (1 m 16 s) (in French only)