Hospitals use several methods to route stroke consults to teleneurologists. Each method has strengths—but also critical limitations.

Telehealth Platforms integrate call and notification alerts as part of their comprehensive package. While exact workflows differ, most platforms allow onsite staff to request a consult and then are placed in a “waiting room” until the provider joins the meeting.

Healthcare Communication Apps give any healthcare worker the ability to create teams and establish communication with other team members about a specific patient. These Apps allow team members from multiple touchpoints along the patient journey to communicate effectively.

The connection type chosen typically rests on the workflow and resources of the hub site that is providing the Telestroke service. There are three different options for the hub site.

• Option 1. A health system is providing Telestroke services from a larger hospital to its smaller and less-resourced sister hospitals.
• Option 2. A health system is providing the service to smaller, regional hospitals that are not within the hospital system.
• Option 3. A hospital has contracted with an outside vendor that provides Telestroke services as a standalone program or to augment their own neurological services.

A call center is typically used to help triage the most acute cases and collect data when many hospitals are linked to a sizable number of vascular neurologists. Call centers collect data and start manual processes however, they are typically for the benefit of the hub site, not the patient site. Utilizing a call center can be associated with multiple limitations; delay in treatment time as the team onsite and the teleneurologist must be connected through a third party, miscommunication of information resulting in confusion and delays, human-error leading to a missed stroke code.

Telehealth platforms exist to incorporate all facets of patient care into one application. While video and audio are paramount to creating a patient/physician relationship, these platforms incorporate additional features such as alerts and notifications to create a comprehensive package. Typically, a direct link or a virtual waiting room is created and when both parties are ready the consultation may begin. Coordination of the provider and the site relies on the teleneurologist to be available when the alert comes through. Many technologies allow for a backup provider to step in when the on-call teleneurologist is busy.

Healthcare Communication apps allow healthcare teams to harness the power of cell phones, and tablets to quickly assemble a team of professionals to assist in patient care. While in the field an EMS team member can identify and alert a predetermined team member of the impending stroke arrival. These communication apps allow for effective communication, documentation, and timestamp validation without the need to purchase disparate hardware. However, there is an assumption that all members of the care team will be able to assist when called upon for this app to work appropriately. This can be especially complicated if the hospital uses a Telestroke vendor to staff their vascular neurologists as the vendor will be less likely to use a technology for only one or two customers.