Background and Purpose: The goals of telestroke programs are to provide safe and efficient stroke care to hospitals. An important marker of efficient acute stroke care delivery is door-to-needle (DTN) time, the time it takes from entrance into the emergency department to administration of alteplase. We sought to determine if DTN time was improving over time within our statewide telestroke network.
Methods: From 5/4/2008-7/12/2015, we prospectively collected data on DTN time from consultations performed in our 18-hospital statewide telestroke network. DTN time was recorded on 765 of the 4985 consults where alteplase recommendations were documented. For all active hospital sites combined, the yearly mean DTN time was determined and compared by year with a one-way ANOVA and Tukey test.
Results: Of the total 6116 consults performed over the time period, there was an average of 95.5 total consults/year among all 18 sites and an average of 8.3 consults/active site/year. The mean +/- SD DTN for all of the consults in all years was 85.4+/-42.0. As shown in the Figure, we found a significant decrease in DTN over time at (p<0.001). In the post-hoc test, the following pairs were determined to be significantly different (at p<0.05): 2008 vs. 2015; 2009 vs. 2013, 2014, and 2015; 2010 vs. 2013, 2014, and 2015; 2011 vs. 2013, 2014, and 2015; 2012 vs. 2013, 2014, and 2015.
Conclusions: Among a statewide Telestroke network, the mean DTN time continued to decrease over the last 7 years, reflecting more efficient delivery of acute stroke treatment. Since more efficient stroke care delivery is associated with better outcomes, this may be a contributing factor to the overall improved stroke mortality within the state.