A case report of the implementation of a telestroke unit in a middle-income country: results and lessons learned from a Mexican pilot.

Objective: To present the results, barriers and facilitators of the implementation of a telestroke network in Mexico. Methods: A telestroke network was implemented to connect a rural hospital to a university hospital with stroke specialists. Patients in the rural hospital were assessed via telemedicine and stroke specialists evaluated and determined the care plan for the patient. The study was conducted from February 2019 to January 2020. Stroke outcomes were measured from patients included in the study, including time to treatment and percentage of patients treated with thrombolysis. Interviews with key stakeholders involved in the program were conducted and analyzed using thematic analysis. Results: Thirteen patients were admitted during the study period, two (15%) patients were treated with thrombolytic therapy and received the treatment within the first two hours from hospital admission. The thematic analysis revealed four themes that contributed to barriers and facilitators to implementing the program: infrastructure, socio-organizational structure, governance, and financial and non-financial incentives. Conclusions: This case study provides relevant lessons for countries with similar characteristics, particularly those in the Latin America region. As telestroke networks continue to develop, it is important to consider these lessons to ensure end-users accept the implementation of telestroke without posing further burden while expanding access to thrombolysis in rural and remote areas.