Telemedicine physician providers: augmented acute stroke care delivery in rural Texas: an initial experience.

We describe the first report of intravenous thrombolytic therapy for acute ischemic stroke given by a rurally based advanced practice nurse (APN) with a telemedicine team of an emergency physician and stroke specialists. A three-way T1 connection between the APN in Dickerson Memorial Hospital in Jasper, TX, the Houston, TX-based Emtel emergency physician, and the University of Texas-Houston Stroke Team physicians facilitated tissue plasminogen activator treatment 80 min into the patient's ischemic stroke, which was manifested by dysarthria, facial palsy, and near-total left-body hemiplegia (NIH Stroke Scale = 9). She was transferred to Memorial Hermann Hospital in Houston for further care. Within 24 h, her neurologic deficits resolved (NIH Stroke Scale = 0), and she was discharged home within 3 days. This represents successful acute stroke care given by an APN under supervision of a telemedicine physician team and may be an option for underserved areas. Educational training of health care providers remains the key for acute stroke care delivery. This case report illustrates a model for telemedicine that has been cost-effective for rural medical care.