Telestroke: Every Minute Matters
In acute ischemic stroke, every minute of delayed treatment results in the loss of approximately 1.9 million neurons. The tPA window closes at 4.5 hours. The thrombectomy window closes at 24 hours. ReasonTele connects your ED with a board-certified vascular neurologist in under 15 minutes — enabling rapid NIHSS assessment, tPA decision-making, and disposition planning that saves lives and reduces disability.
The Telestroke Challenge
Stroke is the fifth leading cause of death in the United States and a leading cause of long-term disability. Despite advances in treatment, most stroke patients never receive the time-critical interventions that could save their lives.
Approximately 87% are ischemic strokes, potentially eligible for tPA if treated within the window. Someone in the United States has a stroke every 40 seconds.
IV alteplase (tPA) must be administered within 4.5 hours of symptom onset for most patients. Earlier treatment is strongly associated with better outcomes — the ideal target is under 60 minutes.
Despite decades of evidence, only 3-5% of ischemic stroke patients receive tPA nationally. The primary barriers are delayed presentation and lack of on-site neurology expertise.
The majority of US hospitals — especially community and rural facilities — do not have a neurologist available around the clock. Patients presenting after hours face significant delays in specialist evaluation.
Without on-demand neurology access, the process of paging a neurologist, waiting for callback, arranging evaluation, and making a tPA decision often exceeds 90 minutes — consuming most of the treatment window.
The combined direct medical costs and lost productivity from stroke exceed $140 billion annually. Timely treatment reduces length of stay, disability, and long-term care costs significantly.
How ReasonTele Telestroke Works
Our six-step telestroke workflow is designed to minimize time-to-neurologist and maximize the likelihood of appropriate tPA administration. Every step is optimized for speed without sacrificing clinical thoroughness.
Stroke Alert Triggered
The ED triage nurse or physician identifies a potential stroke patient. Common triggers include sudden onset of facial droop, arm weakness, speech difficulty (F.A.S.T.), altered consciousness, or abnormal Cincinnati Prehospital Stroke Scale score from EMS.
ReasonTele integrates with hospital stroke alert systems. When a Code Stroke is activated, the platform can automatically pre-populate a consult request with available patient data from the ADT feed.
One-Click Consult Request
The requesting clinician opens ReasonTele and initiates a telestroke consult. The stroke-specific intake form captures last known well time, current symptoms, anticoagulant use, recent surgeries, and other tPA inclusion/exclusion criteria.
Structured intake ensures the neurologist has critical information before the video begins — no time wasted repeating history. Average intake completion time: under 90 seconds.
Automated Specialist Dispatch
The dispatch engine routes the request to the on-call vascular neurologist. The system considers licensure (state-specific), response history, current workload, and time zone. If the primary neurologist does not accept within the SLA window, the request automatically escalates to the backup pool.
Average time from consult request to specialist acceptance: 8 minutes. 95th percentile: under 12 minutes. SLA compliance is tracked in real time.
HIPAA-Compliant Video with NIHSS
The neurologist joins a secure video session with the bedside team. ReasonTele's integrated NIHSS scoring module is available on-screen, allowing the neurologist to assess and score each domain (level of consciousness, gaze, visual fields, facial palsy, motor, ataxia, sensory, language, dysarthria, extinction) during the examination.
The NIHSS score is recorded in real time and included in the final consult note. Screen sharing enables CT/CTA review alongside the video examination.
tPA Recommendation & Communication
Based on the clinical assessment, NIHSS score, imaging review, and inclusion/exclusion criteria, the neurologist provides a tPA recommendation. The built-in tPA checklist ensures no contraindication is missed. The recommendation is communicated verbally and documented in the platform simultaneously.
For tPA-eligible patients, the platform generates a structured tPA order communication with dosing (0.9 mg/kg, max 90 mg, 10% bolus over 1 minute, remainder over 60 minutes) and monitoring parameters.
AI-Generated Consult Note
ReasonNotes AI scribe generates a comprehensive neurology consult note during the encounter. The note includes history of present illness, neurological examination findings, NIHSS score with individual domain scores, imaging interpretation, tPA decision rationale, and disposition plan.
The neurologist reviews and approves the note, then it is automatically delivered to the requesting facility via EMR integration, FHIR API, or secure fax. Average documentation time: under 3 minutes.
Integrated Clinical Tools
ReasonTele is not just a video call. Our telestroke solution includes purpose-built clinical tools that support the neurologist's evaluation workflow, ensure standardized assessments, and reduce the risk of missed contraindications.
Built-in NIHSS Scoring Module
Score each of the 15 NIHSS domains during the video examination. The module guides the neurologist through each assessment item, records individual domain scores, and calculates the total NIHSS score. Historical scores are tracked for serial assessment.
CT/CTA Image Review
Review non-contrast CT and CT angiography images via screen share during the video consult. The neurologist can identify early ischemic changes (ASPECTS scoring), hemorrhage, large vessel occlusion, and other findings that influence treatment decisions.
tPA Inclusion/Exclusion Checklist
A structured checklist of absolute and relative contraindications for IV alteplase administration. The checklist covers recent surgery, active bleeding, anticoagulant use, platelet count, INR, blood pressure thresholds, blood glucose levels, and time from symptom onset — ensuring no contraindication is overlooked.
Last Known Well Time Calculator
Automatically calculates the time elapsed since last known well based on the documented onset time. Provides real-time countdown to the 4.5-hour tPA window and the 24-hour thrombectomy window, with visual alerts as windows approach closure.
Disposition Planning Tools
Structured disposition recommendations including admission to stroke unit, transfer to comprehensive stroke center for thrombectomy, ICU admission for hemorrhagic stroke, or discharge with follow-up. Transfer coordination tools facilitate direct communication with receiving facilities.
Post-tPA Monitoring Protocol
Standardized post-tPA monitoring checklist including vital sign frequency, neurological check intervals, blood pressure parameters, and angioedema monitoring. The protocol is included in the consult note and can be printed as a bedside reference for nursing staff.
Telestroke Outcomes
The evidence for telestroke is unequivocal. Hospitals that deploy 24/7 telestroke programs see dramatic improvements in treatment metrics, patient outcomes, and financial performance. Here is what ReasonTele partner hospitals experience.
The national average door-to-needle time without telestroke exceeds 90 minutes. ReasonTele partner hospitals achieve a median of 42 minutes, well within the AHA/ASA target of 60 minutes.
Only 3-5% of ischemic stroke patients nationally receive tPA. With 24/7 neurologist access and streamlined workflows, ReasonTele partner hospitals increase appropriate tPA administration to 12-18% of ischemic stroke presentations.
Many stroke patients are transferred to comprehensive stroke centers unnecessarily. Telestroke evaluation enables appropriate local treatment, reducing costly interfacility transfers by 40% while ensuring patients who need intervention are transferred promptly.
Timely tPA administration reduces 90-day mortality by approximately 25% for eligible ischemic stroke patients. Every 15-minute reduction in door-to-needle time is associated with measurably improved outcomes including reduced disability.
Transfer cost avoidance (average $15,000-$25,000 per helicopter transfer), reduced length of stay for timely treatment, and improved DRG coding accuracy generate $800K to $1.2M in annual savings for a typical community hospital.
Time Is Brain: The Science Behind Urgency
Research published in Stroke (Saver, 2006) demonstrated that during an average large vessel ischemic stroke, the brain loses approximately 1.9 million neurons, 14 billion synapses, and 12 km of myelinated fibers per minute. For every 15-minute reduction in door-to-needle time, there is a measurable improvement in functional independence at 90 days.
Best chance of full recovery. Odds of favorable outcome 2.8x higher than treatment at 3+ hours.
Still within the AHA/ASA target window. Strong evidence of benefit with minimal additional risk.
Benefit remains significant but begins to decline. Every additional minute matters.
Treatment is still beneficial up to 4.5 hours, but the number needed to treat increases and complication risk rises.
“Before ReasonTele, our door-to-needle time averaged over two hours. We were losing patients to disability — and losing transfers to the comprehensive stroke center 90 miles away. Within three months of deploying ReasonTele telestroke, our median door-to-needle dropped to 38 minutes. We administered tPA to 14% of our ischemic stroke patients last year, up from under 4%. The neurologists are responsive, the NIHSS tool is intuitive for our nurses, and the AI scribe saves our consultants significant documentation time. This platform has fundamentally changed stroke care at our facility.”
Dr. Sarah Mitchell, MD, FACEP
Emergency Department Medical Director, Regional Community Hospital
Who Benefits from ReasonTele Telestroke?
Community Hospitals
- 24/7 neurology coverage without full-time hire
- Reduced helicopter and ground transfers
- Improved stroke quality metrics and Joint Commission compliance
- Enhanced reputation as a stroke-capable facility
- Revenue retention from patients treated locally
Critical Access Hospitals
- Specialist access in rural and underserved areas
- Compliance with stroke-ready hospital designation requirements
- Reduced patient transport time and risk
- Stabilization and tPA initiation before transfer when needed
- Improved community health outcomes
Health Systems & Networks
- Standardized stroke protocols across all facilities
- Centralized performance monitoring and reporting
- Shared specialist pool across system hospitals
- Consistent documentation and coding accuracy
- Network-wide quality improvement initiatives
Every Minute Counts. Start Saving Them Today.
ReasonTele telestroke can be deployed at your facility in as little as two weeks. Our implementation team handles integration, training, and go-live support — so your team can focus on what matters: treating patients. Schedule a demo to see the platform in action and learn how our telestroke program delivers measurable improvements in door-to-needle time, tPA rates, and patient outcomes.