Ruth Forrest MLC talks about stroke in Tasmanian State Parliament
November 29, 2017
Hon Ruth Forrest MLC speech to Tasmanian State parliament about telehealth
In recent days a National Stroke Audit has been released which clearly shows a disturbing truth about the lack of adequate or appropriate care for victims of stroke, particularly in the NW and the North of the State.
Just for a bit of background regarding stroke in Australia:
One stroke occurs every 9 mins
56,000 new strokes each year, of which many occur in regional areas.
Regional Australians are 19 percent more likely to have a stroke than their city counterparts.
Stroke is a leading cause of death and disability, costing over $5 billion/year.
Tasmania has the highest stroke incidence per capita of population.
Stroke in Tasmania
1,453 strokes will be experienced by Tasmanians this year.
12,384 stroke survivors living in Tasmania.
More than 8000 Tasmanian stroke survivors are living with an ongoing disability.
One-in-three stroke survivors are of working age.
Without action by 2050 Tasmanians will experience almost 3,500 strokes annually and there will be more than 25,000 stroke survivors living in the community.
Tasmanians stroke risk
• 108,202 have high blood pressure (19 percent).
• 152,990 have high cholesterol (26.9 percent).
• 262,290 are physically inactive (46.1 percent).
• 12,622 Tasmanians have atrial fibrillation or an irregular heartbeat (2.2 percent).
The NW coast has some of the highest rates of cardio-vascular disease in the State making this area a hot spot for stroke.
I believe this is a matter of equity and will provide some figures broken down by Federal electorate regarding the incidence of stroke.
State Electorate Number of strokes Incidence male Number of stroke survivors
TAS Bass 293 2,455
TAS Braddon 297 2,520
TAS Denison 291 2,389
TAS Franklin292 2,493
TAS Lyons 280 2,527
This means 870 strokes are suffered predominantly in regional electorates based in the north of the state compared with 588 in the southern based electorates.
Very few, if any of those who experience these 870 strokes are receiving life saving and quality of life saving therapies that we can and should be delivering.
This is the reason I am raising this on adjournment. It is a matter of urgency because advancements in stroke treatment and care mean that stroke is no longer a death sentence for many.
However patient outcomes from stroke vary widely depending on where you live and your ability to access appropriate treatment.
The two key treatments include - Thrombolysis (clot dissolving treatment) must occur within the first 4.5 hours of stroke symptoms occurring, and
Endovascular thrombectomy or clot retrieval (ECR) which involves removal of a clot by a retractable mechanical device. This needs to be administered within six hours of stroke symptoms occurring.
Currently, the state has two stroke units, Launceston General Hospital, Royal Hobart Hospital. These both have thrombolysis (clot busting) capabilities.
The Royal Hobart Hospital is the only hospital currently delivering clot removal (endovascular thrombectomy or ECR) however the service is not available 24/7.
There are no services on the NW Coast so this is the area with most need for a new collaborative approach.
Some of the most recent advances in ischemic stroke (caused by a clot) treatment are particularly time critical, and can only be provided within the first few hours of stroke. The earlier treatment is delivered, the better the outcomes for stroke patients.
This is an important matter because if patients can access this timely care they can make a full and rapid recovery with minimal if any residual deficit. These patients are often literally able to walk out of the hospital the following day.
If you compare the costs of establishing these services in the NW and Northern Tasmania with the costs of providing years of care to stroke victims, the loss of productivity and ongoing burden to families and the health budgets, this really should be an easy decision.
I would like to urge the Government to establish a Victorian based and supported Tasmanian tele-medicine stroke service.
A telemedicine enables fast assessment of suspected stroke patients in regional areas by metropolitan based stroke specialists. Regionally based clinicians are supported in administering thrombolysis treatment and/or arranging transfer to a comprehensive stroke centre for ECR treatment.
Victoria has successfully trialled a stroke tele-medicine service which links regional hospitals to senior neurologists at the Royal Melbourne Hospital.
As a result of this link patients right across Victoria are receiving clot busting therapy in their regional hospital and those who can benefit from clot-retrieval therapy are being transferred to the large city hospital for treatment.
A tele-medicine stroke service could be introduced to Tasmania very easily and for a modest cost.
A real, valid and cost-effective option, would be for Tasmanian patients being linked to the Victorian service.
With regard to a comprehensive state-wide ECR treatment system - ECR is technically challenging and should only be performed by highly trained specialists. ECR is currently delivered in Hobart at limited times but the service capabilities of existing infrastructure are insufficient to meet the rapidly increasing demands. There is also the need to develop a state-wide protocol to coordinate transfer of eligible patients to an ECR centre to ensure equitable access for all.
To just provide a brief comment regarding the Victorian Stroke Telemedicine (VST) Program
The Victorian Stroke Telemedicine (VST) program allows people living in rural and regional areas to quickly access stroke specialists and new acute stroke therapies, such as clot busting and clot removal treatments.
Until now, regional hospital emergency departments have often been unable to give these therapies as patients with stroke require detailed assessment by a specialist with stroke expertise to ensure a patient is suitable for treatment.
This is important because “Time is Brain” – therapies must be given as soon as possible after symptoms commence to achieve the best possible outcomes. The VST program is unique in Australia and works by seamlessly connecting 16 Victorian rural and regional emergency departments to a roster of metropolitan-based neurologists.
The neurologists are accessible every day, all day (24/7/365) via a single 1300 telephone number. Through new “state-of-the-art” mobile technology and software, the stroke specialist can remotely examine patients at the bedside, review brain imaging and provide rapid diagnosis and treatment advice in consultation with local clinicians and the patient, irrespective of their geographic location.
The VST program first commenced in 2010 and has received funding support funding from the Commonwealth Department of Health, the Victorian Department of Health (Victorian Stroke Clinical Network), Monash University, amongst others.
The VST program has deployed fully integrated telemedicine technology in Emergency Departments in all 16 hospitals in regional Victoria. There is extensive data collection and ongoing monitoring of VST activity and clinical outcomes, with use of the Australian Stroke Clinical Registry (AuSCR), supporting a full clinical and health economic evaluation of the VST program. The evidence is clear – this system works.
This program has seen a:
• 130% increase in patients with acute stroke treated under 60 mins of hospital arrival
• 30% decrease in treatment time – e.g. door to CT, door to stroke thrombolysis times
• 60% decrease in complications following thrombolysis
The VST program has been very successful and has delivered equity of access to acute stroke care for people living in regional Victoria.
I support the notion that this telestroke model can be expanded to Northern Tasmania.
I am informed that the establishment of this service would be highly cost effective.
The estimate in terms of costs would be approximately $500k over the forward estimates period including the initial set up costs including an ongoing estimated cost of $80k to maintain operations of the service once established.
Costs are not yet finalised and work is currently underway to fully determine set up and ongoing costs to deliver such an important service.
When one considers the significant costs associated with caring for stroke victims who are not being provided with the quality care others in the south of the State and occasionally in the North, but never in the NW, is simply not ok.
This inequity of care means people living in the North of State are receiving substandard care and we are not doing our best for them.
The Victorian based Tasmanian tele-medicine stroke service. We don’t need to reinvent the wheel, the evidence is clear and the service proven.
I acknowledge we do not have the critical mass of population and/or neurologists to provide a 24 hour, seven day a week, service. It makes sense to link with a tried and proven service and save millions of dollars, save lives and improve patient outcomes in a totally cost effective manner.
I urge the Government, and the opposition to fully assess and consider this important health care opportunity for all these reasons.
Adjournment – National Stroke Audit
In recent days a National Stroke Audit has been released which clearly shows a disturbing truth about the lack of adequate or appropriate care for victims of stroke, particularly in the NW and the North of the State.
Just for a bit of background regarding stroke in Australia:
One stroke occurs every 9 mins
56,000 new strokes each year, of which many occur in regional areas.
Regional Australians are 19 percent more likely to have a stroke than their city counterparts.
Stroke is a leading cause of death and disability, costing over $5 billion/year.
Tasmania has the highest stroke incidence per capita of population.
Stroke in Tasmania
1,453 strokes will be experienced by Tasmanians this year.
12,384 stroke survivors living in Tasmania.
More than 8000 Tasmanian stroke survivors are living with an ongoing disability.
One-in-three stroke survivors are of working age.
Without action by 2050 Tasmanians will experience almost 3,500 strokes annually and there will be more than 25,000 stroke survivors living in the community.
Tasmanians stroke risk
• 108,202 have high blood pressure (19 percent).
• 152,990 have high cholesterol (26.9 percent).
• 262,290 are physically inactive (46.1 percent).
• 12,622 Tasmanians have atrial fibrillation or an irregular heartbeat (2.2 percent).
The NW coast has some of the highest rates of cardio-vascular disease in the State making this area a hot spot for stroke.
I believe this is a matter of equity and will provide some figures broken down by Federal electorate regarding the incidence of stroke.
State Electorate Number of strokes Incidence male Number of stroke survivors
TAS Bass 293 2,455
TAS Braddon 297 2,520
TAS Denison 291 2,389
TAS Franklin292 2,493
TAS Lyons 280 2,527
This means 870 strokes are suffered predominantly in regional electorates based in the north of the state compared with 588 in the southern based electorates.
Very few, if any of those who experience these 870 strokes are receiving life saving and quality of life saving therapies that we can and should be delivering.
This is the reason I am raising this on adjournment. It is a matter of urgency because advancements in stroke treatment and care mean that stroke is no longer a death sentence for many.
However patient outcomes from stroke vary widely depending on where you live and your ability to access appropriate treatment.
The two key treatments include - Thrombolysis (clot dissolving treatment) must occur within the first 4.5 hours of stroke symptoms occurring, and
Endovascular thrombectomy or clot retrieval (ECR) which involves removal of a clot by a retractable mechanical device. This needs to be administered within six hours of stroke symptoms occurring.
Currently, the state has two stroke units, Launceston General Hospital, Royal Hobart Hospital. These both have thrombolysis (clot busting) capabilities.
The Royal Hobart Hospital is the only hospital currently delivering clot removal (endovascular thrombectomy or ECR) however the service is not available 24/7.
There are no services on the NW Coast so this is the area with most need for a new collaborative approach.
Some of the most recent advances in ischemic stroke (caused by a clot) treatment are particularly time critical, and can only be provided within the first few hours of stroke. The earlier treatment is delivered, the better the outcomes for stroke patients.
This is an important matter because if patients can access this timely care they can make a full and rapid recovery with minimal if any residual deficit. These patients are often literally able to walk out of the hospital the following day.
If you compare the costs of establishing these services in the NW and Northern Tasmania with the costs of providing years of care to stroke victims, the loss of productivity and ongoing burden to families and the health budgets, this really should be an easy decision.
I would like to urge the Government to establish a Victorian based and supported Tasmanian tele-medicine stroke service.
A telemedicine enables fast assessment of suspected stroke patients in regional areas by metropolitan based stroke specialists. Regionally based clinicians are supported in administering thrombolysis treatment and/or arranging transfer to a comprehensive stroke centre for ECR treatment.
Victoria has successfully trialled a stroke tele-medicine service which links regional hospitals to senior neurologists at the Royal Melbourne Hospital.
As a result of this link patients right across Victoria are receiving clot busting therapy in their regional hospital and those who can benefit from clot-retrieval therapy are being transferred to the large city hospital for treatment.
A tele-medicine stroke service could be introduced to Tasmania very easily and for a modest cost.
A real, valid and cost-effective option, would be for Tasmanian patients being linked to the Victorian service.
With regard to a comprehensive state-wide ECR treatment system - ECR is technically challenging and should only be performed by highly trained specialists. ECR is currently delivered in Hobart at limited times but the service capabilities of existing infrastructure are insufficient to meet the rapidly increasing demands. There is also the need to develop a state-wide protocol to coordinate transfer of eligible patients to an ECR centre to ensure equitable access for all.
To just provide a brief comment regarding the Victorian Stroke Telemedicine (VST) Program
The Victorian Stroke Telemedicine (VST) program allows people living in rural and regional areas to quickly access stroke specialists and new acute stroke therapies, such as clot busting and clot removal treatments.
Until now, regional hospital emergency departments have often been unable to give these therapies as patients with stroke require detailed assessment by a specialist with stroke expertise to ensure a patient is suitable for treatment.
This is important because “Time is Brain” – therapies must be given as soon as possible after symptoms commence to achieve the best possible outcomes. The VST program is unique in Australia and works by seamlessly connecting 16 Victorian rural and regional emergency departments to a roster of metropolitan-based neurologists.
The neurologists are accessible every day, all day (24/7/365) via a single 1300 telephone number. Through new “state-of-the-art” mobile technology and software, the stroke specialist can remotely examine patients at the bedside, review brain imaging and provide rapid diagnosis and treatment advice in consultation with local clinicians and the patient, irrespective of their geographic location.
The VST program first commenced in 2010 and has received funding support funding from the Commonwealth Department of Health, the Victorian Department of Health (Victorian Stroke Clinical Network), Monash University, amongst others.
The VST program has deployed fully integrated telemedicine technology in Emergency Departments in all 16 hospitals in regional Victoria. There is extensive data collection and ongoing monitoring of VST activity and clinical outcomes, with use of the Australian Stroke Clinical Registry (AuSCR), supporting a full clinical and health economic evaluation of the VST program. The evidence is clear – this system works.
This program has seen a:
• 130% increase in patients with acute stroke treated under 60 mins of hospital arrival
• 30% decrease in treatment time – e.g. door to CT, door to stroke thrombolysis times
• 60% decrease in complications following thrombolysis
The VST program has been very successful and has delivered equity of access to acute stroke care for people living in regional Victoria.
I support the notion that this telestroke model can be expanded to Northern Tasmania.
I am informed that the establishment of this service would be highly cost effective.
The estimate in terms of costs would be approximately $500k over the forward estimates period including the initial set up costs including an ongoing estimated cost of $80k to maintain operations of the service once established.
Costs are not yet finalised and work is currently underway to fully determine set up and ongoing costs to deliver such an important service.
When one considers the significant costs associated with caring for stroke victims who are not being provided with the quality care others in the south of the State and occasionally in the North, but never in the NW, is simply not ok.
This inequity of care means people living in the North of State are receiving substandard care and we are not doing our best for them.
The Victorian based Tasmanian tele-medicine stroke service. We don’t need to reinvent the wheel, the evidence is clear and the service proven.
I acknowledge we do not have the critical mass of population and/or neurologists to provide a 24 hour, seven day a week, service. It makes sense to link with a tried and proven service and save millions of dollars, save lives and improve patient outcomes in a totally cost effective manner.
I urge the Government, and the opposition to fully assess and consider this important health care opportunity for all these reasons.
In recent days a National Stroke Audit has been released which clearly shows a disturbing truth about the lack of adequate or appropriate care for victims of stroke, particularly in the NW and the North of the State.
Just for a bit of background regarding stroke in Australia:
One stroke occurs every 9 mins
56,000 new strokes each year, of which many occur in regional areas.
Regional Australians are 19 percent more likely to have a stroke than their city counterparts.
Stroke is a leading cause of death and disability, costing over $5 billion/year.
Tasmania has the highest stroke incidence per capita of population.
Stroke in Tasmania
1,453 strokes will be experienced by Tasmanians this year.
12,384 stroke survivors living in Tasmania.
More than 8000 Tasmanian stroke survivors are living with an ongoing disability.
One-in-three stroke survivors are of working age.
Without action by 2050 Tasmanians will experience almost 3,500 strokes annually and there will be more than 25,000 stroke survivors living in the community.
Tasmanians stroke risk
• 108,202 have high blood pressure (19 percent).
• 152,990 have high cholesterol (26.9 percent).
• 262,290 are physically inactive (46.1 percent).
• 12,622 Tasmanians have atrial fibrillation or an irregular heartbeat (2.2 percent).
The NW coast has some of the highest rates of cardio-vascular disease in the State making this area a hot spot for stroke.
I believe this is a matter of equity and will provide some figures broken down by Federal electorate regarding the incidence of stroke.
State Electorate Number of strokes Incidence male Number of stroke survivors
TAS Bass 293 2,455
TAS Braddon 297 2,520
TAS Denison 291 2,389
TAS Franklin292 2,493
TAS Lyons 280 2,527
This means 870 strokes are suffered predominantly in regional electorates based in the north of the state compared with 588 in the southern based electorates.
Very few, if any of those who experience these 870 strokes are receiving life saving and quality of life saving therapies that we can and should be delivering.
This is the reason I am raising this on adjournment. It is a matter of urgency because advancements in stroke treatment and care mean that stroke is no longer a death sentence for many.
However patient outcomes from stroke vary widely depending on where you live and your ability to access appropriate treatment.
The two key treatments include - Thrombolysis (clot dissolving treatment) must occur within the first 4.5 hours of stroke symptoms occurring, and
Endovascular thrombectomy or clot retrieval (ECR) which involves removal of a clot by a retractable mechanical device. This needs to be administered within six hours of stroke symptoms occurring.
Currently, the state has two stroke units, Launceston General Hospital, Royal Hobart Hospital. These both have thrombolysis (clot busting) capabilities.
The Royal Hobart Hospital is the only hospital currently delivering clot removal (endovascular thrombectomy or ECR) however the service is not available 24/7.
There are no services on the NW Coast so this is the area with most need for a new collaborative approach.
Some of the most recent advances in ischemic stroke (caused by a clot) treatment are particularly time critical, and can only be provided within the first few hours of stroke. The earlier treatment is delivered, the better the outcomes for stroke patients.
This is an important matter because if patients can access this timely care they can make a full and rapid recovery with minimal if any residual deficit. These patients are often literally able to walk out of the hospital the following day.
If you compare the costs of establishing these services in the NW and Northern Tasmania with the costs of providing years of care to stroke victims, the loss of productivity and ongoing burden to families and the health budgets, this really should be an easy decision.
I would like to urge the Government to establish a Victorian based and supported Tasmanian tele-medicine stroke service.
A telemedicine enables fast assessment of suspected stroke patients in regional areas by metropolitan based stroke specialists. Regionally based clinicians are supported in administering thrombolysis treatment and/or arranging transfer to a comprehensive stroke centre for ECR treatment.
Victoria has successfully trialled a stroke tele-medicine service which links regional hospitals to senior neurologists at the Royal Melbourne Hospital.
As a result of this link patients right across Victoria are receiving clot busting therapy in their regional hospital and those who can benefit from clot-retrieval therapy are being transferred to the large city hospital for treatment.
A tele-medicine stroke service could be introduced to Tasmania very easily and for a modest cost.
A real, valid and cost-effective option, would be for Tasmanian patients being linked to the Victorian service.
With regard to a comprehensive state-wide ECR treatment system - ECR is technically challenging and should only be performed by highly trained specialists. ECR is currently delivered in Hobart at limited times but the service capabilities of existing infrastructure are insufficient to meet the rapidly increasing demands. There is also the need to develop a state-wide protocol to coordinate transfer of eligible patients to an ECR centre to ensure equitable access for all.
To just provide a brief comment regarding the Victorian Stroke Telemedicine (VST) Program
The Victorian Stroke Telemedicine (VST) program allows people living in rural and regional areas to quickly access stroke specialists and new acute stroke therapies, such as clot busting and clot removal treatments.
Until now, regional hospital emergency departments have often been unable to give these therapies as patients with stroke require detailed assessment by a specialist with stroke expertise to ensure a patient is suitable for treatment.
This is important because “Time is Brain” – therapies must be given as soon as possible after symptoms commence to achieve the best possible outcomes. The VST program is unique in Australia and works by seamlessly connecting 16 Victorian rural and regional emergency departments to a roster of metropolitan-based neurologists.
The neurologists are accessible every day, all day (24/7/365) via a single 1300 telephone number. Through new “state-of-the-art” mobile technology and software, the stroke specialist can remotely examine patients at the bedside, review brain imaging and provide rapid diagnosis and treatment advice in consultation with local clinicians and the patient, irrespective of their geographic location.
The VST program first commenced in 2010 and has received funding support funding from the Commonwealth Department of Health, the Victorian Department of Health (Victorian Stroke Clinical Network), Monash University, amongst others.
The VST program has deployed fully integrated telemedicine technology in Emergency Departments in all 16 hospitals in regional Victoria. There is extensive data collection and ongoing monitoring of VST activity and clinical outcomes, with use of the Australian Stroke Clinical Registry (AuSCR), supporting a full clinical and health economic evaluation of the VST program. The evidence is clear – this system works.
This program has seen a:
• 130% increase in patients with acute stroke treated under 60 mins of hospital arrival
• 30% decrease in treatment time – e.g. door to CT, door to stroke thrombolysis times
• 60% decrease in complications following thrombolysis
The VST program has been very successful and has delivered equity of access to acute stroke care for people living in regional Victoria.
I support the notion that this telestroke model can be expanded to Northern Tasmania.
I am informed that the establishment of this service would be highly cost effective.
The estimate in terms of costs would be approximately $500k over the forward estimates period including the initial set up costs including an ongoing estimated cost of $80k to maintain operations of the service once established.
Costs are not yet finalised and work is currently underway to fully determine set up and ongoing costs to deliver such an important service.
When one considers the significant costs associated with caring for stroke victims who are not being provided with the quality care others in the south of the State and occasionally in the North, but never in the NW, is simply not ok.
This inequity of care means people living in the North of State are receiving substandard care and we are not doing our best for them.
The Victorian based Tasmanian tele-medicine stroke service. We don’t need to reinvent the wheel, the evidence is clear and the service proven.
I acknowledge we do not have the critical mass of population and/or neurologists to provide a 24 hour, seven day a week, service. It makes sense to link with a tried and proven service and save millions of dollars, save lives and improve patient outcomes in a totally cost effective manner.
I urge the Government, and the opposition to fully assess and consider this important health care opportunity for all these reasons.
In recent days a National Stroke Audit has been released which clearly shows a disturbing truth about the lack of adequate or appropriate care for victims of stroke, particularly in the NW and the North of the State.
Just for a bit of background regarding stroke in Australia:
One stroke occurs every 9 mins
56,000 new strokes each year, of which many occur in regional areas.
Regional Australians are 19 percent more likely to have a stroke than their city counterparts.
Stroke is a leading cause of death and disability, costing over $5 billion/year.
Tasmania has the highest stroke incidence per capita of population.
Stroke in Tasmania
1,453 strokes will be experienced by Tasmanians this year.
12,384 stroke survivors living in Tasmania.
More than 8000 Tasmanian stroke survivors are living with an ongoing disability.
One-in-three stroke survivors are of working age.
Without action by 2050 Tasmanians will experience almost 3,500 strokes annually and there will be more than 25,000 stroke survivors living in the community.
Tasmanians stroke risk
• 108,202 have high blood pressure (19 percent).
• 152,990 have high cholesterol (26.9 percent).
• 262,290 are physically inactive (46.1 percent).
• 12,622 Tasmanians have atrial fibrillation or an irregular heartbeat (2.2 percent).
The NW coast has some of the highest rates of cardio-vascular disease in the State making this area a hot spot for stroke.
I believe this is a matter of equity and will provide some figures broken down by Federal electorate regarding the incidence of stroke.
State Electorate Number of strokes Incidence male Number of stroke survivors
TAS Bass 293 2,455
TAS Braddon 297 2,520
TAS Denison 291 2,389
TAS Franklin292 2,493
TAS Lyons 280 2,527
This means 870 strokes are suffered predominantly in regional electorates based in the north of the state compared with 588 in the southern based electorates.
Very few, if any of those who experience these 870 strokes are receiving life saving and quality of life saving therapies that we can and should be delivering.
This is the reason I am raising this on adjournment. It is a matter of urgency because advancements in stroke treatment and care mean that stroke is no longer a death sentence for many.
However patient outcomes from stroke vary widely depending on where you live and your ability to access appropriate treatment.
The two key treatments include - Thrombolysis (clot dissolving treatment) must occur within the first 4.5 hours of stroke symptoms occurring, and
Endovascular thrombectomy or clot retrieval (ECR) which involves removal of a clot by a retractable mechanical device. This needs to be administered within six hours of stroke symptoms occurring.
Currently, the state has two stroke units, Launceston General Hospital, Royal Hobart Hospital. These both have thrombolysis (clot busting) capabilities.
The Royal Hobart Hospital is the only hospital currently delivering clot removal (endovascular thrombectomy or ECR) however the service is not available 24/7.
There are no services on the NW Coast so this is the area with most need for a new collaborative approach.
Some of the most recent advances in ischemic stroke (caused by a clot) treatment are particularly time critical, and can only be provided within the first few hours of stroke. The earlier treatment is delivered, the better the outcomes for stroke patients.
This is an important matter because if patients can access this timely care they can make a full and rapid recovery with minimal if any residual deficit. These patients are often literally able to walk out of the hospital the following day.
If you compare the costs of establishing these services in the NW and Northern Tasmania with the costs of providing years of care to stroke victims, the loss of productivity and ongoing burden to families and the health budgets, this really should be an easy decision.
I would like to urge the Government to establish a Victorian based and supported Tasmanian tele-medicine stroke service.
A telemedicine enables fast assessment of suspected stroke patients in regional areas by metropolitan based stroke specialists. Regionally based clinicians are supported in administering thrombolysis treatment and/or arranging transfer to a comprehensive stroke centre for ECR treatment.
Victoria has successfully trialled a stroke tele-medicine service which links regional hospitals to senior neurologists at the Royal Melbourne Hospital.
As a result of this link patients right across Victoria are receiving clot busting therapy in their regional hospital and those who can benefit from clot-retrieval therapy are being transferred to the large city hospital for treatment.
A tele-medicine stroke service could be introduced to Tasmania very easily and for a modest cost.
A real, valid and cost-effective option, would be for Tasmanian patients being linked to the Victorian service.
With regard to a comprehensive state-wide ECR treatment system - ECR is technically challenging and should only be performed by highly trained specialists. ECR is currently delivered in Hobart at limited times but the service capabilities of existing infrastructure are insufficient to meet the rapidly increasing demands. There is also the need to develop a state-wide protocol to coordinate transfer of eligible patients to an ECR centre to ensure equitable access for all.
To just provide a brief comment regarding the Victorian Stroke Telemedicine (VST) Program
The Victorian Stroke Telemedicine (VST) program allows people living in rural and regional areas to quickly access stroke specialists and new acute stroke therapies, such as clot busting and clot removal treatments.
Until now, regional hospital emergency departments have often been unable to give these therapies as patients with stroke require detailed assessment by a specialist with stroke expertise to ensure a patient is suitable for treatment.
This is important because “Time is Brain” – therapies must be given as soon as possible after symptoms commence to achieve the best possible outcomes. The VST program is unique in Australia and works by seamlessly connecting 16 Victorian rural and regional emergency departments to a roster of metropolitan-based neurologists.
The neurologists are accessible every day, all day (24/7/365) via a single 1300 telephone number. Through new “state-of-the-art” mobile technology and software, the stroke specialist can remotely examine patients at the bedside, review brain imaging and provide rapid diagnosis and treatment advice in consultation with local clinicians and the patient, irrespective of their geographic location.
The VST program first commenced in 2010 and has received funding support funding from the Commonwealth Department of Health, the Victorian Department of Health (Victorian Stroke Clinical Network), Monash University, amongst others.
The VST program has deployed fully integrated telemedicine technology in Emergency Departments in all 16 hospitals in regional Victoria. There is extensive data collection and ongoing monitoring of VST activity and clinical outcomes, with use of the Australian Stroke Clinical Registry (AuSCR), supporting a full clinical and health economic evaluation of the VST program. The evidence is clear – this system works.
This program has seen a:
• 130% increase in patients with acute stroke treated under 60 mins of hospital arrival
• 30% decrease in treatment time – e.g. door to CT, door to stroke thrombolysis times
• 60% decrease in complications following thrombolysis
The VST program has been very successful and has delivered equity of access to acute stroke care for people living in regional Victoria.
I support the notion that this telestroke model can be expanded to Northern Tasmania.
I am informed that the establishment of this service would be highly cost effective.
The estimate in terms of costs would be approximately $500k over the forward estimates period including the initial set up costs including an ongoing estimated cost of $80k to maintain operations of the service once established.
Costs are not yet finalised and work is currently underway to fully determine set up and ongoing costs to deliver such an important service.
When one considers the significant costs associated with caring for stroke victims who are not being provided with the quality care others in the south of the State and occasionally in the North, but never in the NW, is simply not ok.
This inequity of care means people living in the North of State are receiving substandard care and we are not doing our best for them.
The Victorian based Tasmanian tele-medicine stroke service. We don’t need to reinvent the wheel, the evidence is clear and the service proven.
I acknowledge we do not have the critical mass of population and/or neurologists to provide a 24 hour, seven day a week, service. It makes sense to link with a tried and proven service and save millions of dollars, save lives and improve patient outcomes in a totally cost effective manner.
I urge the Government, and the opposition to fully assess and consider this important health care opportunity for all these reasons.