Hindawi Publishing Corporation International Journal of Telemedicine and Applications Volume 2010, Article ID 507071, 5 pages doi:10.1155/2010/507071 Research Article Vascular Neurology Nurse Practitioner Provision of Telemedicine Consultations Bart M. Demaerschalk, Terri-Ellen J. Kiernan, and STARR Investigators Division of Cerebrovascular Diseases and Division of Critical Care Neurology, Department of Neurology, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA Correspondence should be addressed to Bart M. Demaerschalk, demaerschalk.bart@mayo.edu Received 9 November 2009; Revised 20 April 2010; Accepted 22 June 2010 Academic Editor: Athanasios Demiris Copyright © 2010 Bart M. Demaerschalk et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. The objective was to deﬁne and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP) in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods. Prospective stroke alert patients at participating hospitals underwent a two-way audio video telemedicine consultation with a VN-NP at a remotely located stroke center in partnership with a vascular neurologist. Demographic information, National Institutes of Health Stroke Scale (NIHSS) scores, diagnoses, CT contraindications to thrombolysis, thrombolysis eligibility, and time interval data were collected. The inter-rater agreement between VN-NP and vascular neurologist assessments was calculated. Results. Ten patients were evaluated. Four were determined to have ischemic stroke, one had a transient ischemic attack, two had intracerebral hemorrhages, and three were stroke mimics. Overall, three patients received thrombolysis. The inter-rater agreement between VN-NP and vascular neurologist assessments were excellent, ranging from 0.9 to 1.0. The duration of VN-NP consultation was 53.2 ± 9.0 minutes, which included the vascular neurologist supervisory evaluation time of 12.0 ± 9.6 minutes. Conclusion. This study illustrated that a stroke center VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to remotely located rural emergency departments within a hub and spoke network. VN-NPs may fulﬁll the role of a telestroke provider. 1. Introduction The purpose of this preliminary study was to deﬁne, demonstrate, and evaluate a role for the vascular neurology nurse practitioner (VN-NP) in the delivery of telemedicine consultations in partnership with a vascular neurologist in the context of an established hub and spoke stroke telemedicine network. NPs, physician assistants (PAs), and other physician extenders are no longer being relegated to subservient roles in health-care delivery. They are assuming an ever-increasing level of responsibility in patient care. With technological enablers, such as telemedicine, physician extenders’ future roles as specialty caregivers in rural com- munities will grow. Examples of physician—NP telemedicine partnerships already exist in rural emergency medicine, but none describe the potential role of a VN-NP telemedicine provider responding to cases of acute stroke. Physician extenders and midlevel providers have prac- ticed emergency medicine for 25 years or more [1]. In the United States, it is estimated that NP and PA are involved in 1.8% and 6.5%, respectively, of emergency department consultations [2]. Nearly half of all emergency departments employ midlevel providers [3]. Historically, emergency medicine midlevel providers were positioned in the hospital; when or if, supervision was necessary, emergency physicians and/or medical or surgical specialists were consulted. With telemedicine, an NP positioned in an emergency department could consult a remotely located physician. For example, in the published program, “TelEmergency for rural hospi- tals,” emergency NP collaborated with remote TelEmergency physicians to treat patients [4]. The NP was required to have speciﬁc qualiﬁcations, including master’s degree, certiﬁca- tion as a family NP with an unrestricted license, and state license eligibility [4]. In the TelEmergency system, the cost