Background: Telestroke (TS) is well established, yet there is a lack of large-scale, outcomes data on TS effectiveness to improve acute treatment in rural systems of care. Specialist On Call © is the largest national provider of tele-emergency consults, with > 23,000 consults/yr.; 61% are acute stroke consults. Funded by a HRSA grant, we evaluated effectiveness of TS programs to improve access and timeliness of tPA treatment n the UVA Telestroke and SOC tele network of rural hospitals.
Methods: Phase I: Rural hospitals were defined by OMB standards. Aggregated SOC data were pooled from 46 hospitals 2012-15; (4,462 consults). 73% of patient encounters (3,247) were t ischemic strokes (AIS); 19% (578) were tPA treated. Data were analyzed for demographics, NIHSS score, % patients treated tPA < 60 min, and % treated within 3 hrs. of LSN. Phase II: An online CEU/CME telestroke-presenter training program was designed to teach emergency staff clinical/technical skills to facilitate TS encounters. http://www.startelehealth.org/.
Results: 53% of AIS patients were ≥ 65 yo; 47% ≤ 65 yo. In AIS patients, NIHSS was 0-8 in 79%, 9-15 in 11%, and 16-40 in 9.6%. For tPA treated patients, NIHSS was 0-8 in 53%, 9-15 in 23 % and 16-40 in 25%. A total of 73.2% of tPA patients were treated 180 min from LSN. 16.8% of AIS patients received tPA within 4.5 hrs of LSN. DTN median time was 83 min. 22% received tPA ≤ 60 min DTN. Patient arrival to SOC call initiated was 44 min (median). Call to video consult was 20min for both AIS and tPA patients. Phase II: Stroke protocol packets are being piloted in rural TS hospitals, and online telepresenter training has been launched (in progress).
Conclusions: This is the largest outcomes study of acute TS encounters in rural US hospitals. Treatment in AIS with tPA was high (19%) indicating increased access to acute tele-neurological expertise. Teleconsultation physician response time was rapid, while patient arrival to SOC call time was much longer. Work is needed to ensure better adherence to DTN < 60min in rural hospitals consistent with AHA-ASA GL. In Phase II, we will determine impact of TS education programs to improve timeliness of treatment (stroke-specific tele-presenter training & triage protocols) in comparison to control.