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Telemedicine links increasingly extend scarce neurologic services to underserved areas. Given the urgency of administering the FDA-approved clot-busting drug intravenous recombinant tissue plasminogen activator (t-PA) to reduce long-term, disabling effects of acute ischemic strokes, for hospitalists working in settings without timely inpatient access to stroke specialists, these arrangements can be lifesavers.

A telestroke system implemented by Dallas-based hospitalist company Eagle Hospital Physicians at South Fulton Medical Center in East Point, Ga., has enabled that hospital to achieve certification as a primary stroke center using coverage from remotely based "teleneurologists." But onsite presence of hospitalists and their integration into the stroke service are keys to its success, says Karim Godamunne, MD, MBA, FHM, FPHM, director of the hospitalist service at South Fulton and founder of the stroke program.

"My responsibility is for overall quality of the program, use of guidelines, tracking quality measures, and the like," Dr. Godamunne explains.

Around-the-clock coverage is provided by four board-certified vascular neurologists who work at other Atlanta-area hospitals and can "beam in" electronically upon request within 15 minutes of admission to consult on a stroke case. Typically, the teleneurologists are accessed by physicians in the ED or by hospitalists. South Fulton has one part-time neurologist on staff and a neurologic nurse practitioner who coordinates the stroke service. "All of the stroke patients get oversight and daily visits from the hospitalists to maintain quality," he says.

Eagle manages hospitalist programs in 25 hospitals in 10 primarily southeastern states. Dr. Godamunne also serves as hosting faculty for a remotely broadcast medical workshop on leveraging remote presence to meet inpatient needs, offered by Eagle's Remote Presence University.

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