Introduction: Access to organised stroke unit care in regional hospitals is limited. BUILDS, a novel tele-stroke unit model, was piloted at Echuca Regional Health (ERH) in 2021, and implemented at North West Regional Hospital (NWRH) in 2023. Key variables in BUILDS were compared across two hospitals during the project implementation phase.
Methods: BUILDS provided funding for a part-time stroke coordinator and virtual ward round by a stroke neurologist during weekdays at both hospitals. NWRH was supported by one existing clinical nurse consultant position and two general physicians with interest in stroke.
Relevant variables were extracted from the implementation phase of consultation records (11 months).
Results: 110 (89% initial) vs 107 consultations (69% initial) were conducted at NWRH and ERH respectively. Median age was 76 (IQR 67-83) and 73 (IQR 65-82) at NWRH and ERH respectively. Median times for pre-consultation discussion were 15 minutes (IQR 10-20) NWRH and 10 minutes (IQR 10-15) ERH. Median time for patient consultation was 10 minutes for both sites.
Conclusion: Diagnosis was revised 14% (NWRH) compared to 29% (ERH). Medications were revised for 44% NWRH and 48% ERH. In eight (NWRH) and seven (ERH) instances changes present on imaging were identified and reviewed during case discussion but not previously identified in the radiology reports. 8/110 NWRH and 14/107 ERH consultations had further imaging ordered, with investigations cancelled in 9/110 NWRH and 13/107 ERH cases.
Relevance to clinical practice or patient experience: Tele-stroke unit model improves diagnostic accuracy, care provision and provides external quality assurance in imaging interpretation for stroke patients in regional hospitals.