Bridging the Urban and regIonaL Divide in Stroke care (BUILDS): A national Tele-Stroke Unit Inpatient Service for regional, rural and remote Australia

The telestroke inpatient service will include eight intervention elements reflecting best practices for setting up a Stroke Care Unit to achieve status as a Stroke Capable Regional General Hospital (SCRGH): 1. Geographically co-located beds for stroke patients 2. Stroke clinician-led virtual ward rounds for all confirmed/suspected stroke admissions within the next working day, with a pre-round multi-disciplinary meeting to formulate a preliminary plan prior to seeing the patient. Minimum attendees for the virtual ward round are the stroke physician, local stroke coordinator and representative from the local medical team. 3. Provision of telehealth device hardware and stroke-focused digital clinical platform. The hardware provided will be a portable device with audio/video capability (eg iPad or similar) on a rolling stand. The web-based digital platform which will be used at all sites for clinical documentation of telestroke consultations and data collection for the trial. 4. Consulting neurologist will provide support and be available for Invitation to primary care providers and carers to discharge/family meetings with primary care providers and/or carers to discuss discharge plans 5. Hiring (or increasing FTE) of a stroke coordinator at each regional site, with partial salary support provided by the study 6. Hiring (or increasing FTE) of an Aboriginal Liaison Officer, with partial salary support provided by the study 7. Structured stroke education programs for staff and primary care providers with a focus on rural care. This will include medical, nursing and allied health staff. 8. Periodic audits for quality assurance and improvement All interventions will commence simultaneously 2 weeks (to allow for initiation of intervention measures) after the 18 month control period. The intervention period will last 18 months. The stroke coordinator and telehealth consultations are mandatory at each site. Fidelity to the interventions will be monitored by the process evaluation team, through medical record review and staff/organisational surveys and interviews. Training programs for stroke coordinator and Aboriginal liaison officer roles are in development as part of the trial and will commence prior to the intervention period. It will be delivered via webinar and designed to upskill new or existing coordinators and ALOs in stroke-specific care. Further details will be provided on the registry before the study begins.