Background: Telestroke (TS) has been used to provide acute stroke care through a variety of different models. Two of these include an external vendor model (EVM), where care is provided by specialists that are not intrinsically related to the hospitals to which the care is being delivered, and another is an internally designed model (IDM) run by neurologists employed by the same hospital system. Our hospital system at Kaiser Permanente employed coverage via an outside vendor at certain sites as well as concurrently used an internally designed telestroke program at other sites.
Objective: We aimed to determine if an IDM would provide quicker telestroke services and improve the door to needle time (DTN) to that provided by EVM in the management of acute ischemic stroke.
Methods: Charts in which tPA was administered using TS, from 1/1/2015 to 12/31/2015, were retrospectively reviewed from two different medical centers of similar size and patient volume. One center utilized an EVM while the other employed an IDM. Several metrics were compared including DTN, door to telestroke consultation time and call back time from telestroke neurologist. A 2 tailed T-test was used to compare the differences between both groups.
Results: Thirty three patients received tPA via IDM, and 37 patients via EVM. The median door to telestroke consultation placement time was 11 minutes (mins) in both hospitals (p=0.10). The median telestroke physician call back was 16 (IQR 13-18) mins in EVM vs. 7 (IQR 10-24) mins in IDM (p=0.024). The overall door to telestroke consultation was 44 (IQR 29-40) mins in the EVM vs. 21 (IQR 14-40) mins in IDM (P=0.006). The median DTN was 86 (IQR 69-107) mins in EVM vs. 51 (IQR 42-70) mins in IDM (p= 0.005).
Conclusion: The IDM cohort had quicker call back and consultation times compared to the EVM group. However, there was no difference between door to consult placement time helping to remove local emergency department variability. This suggests that a model that is internally developed with physicians intrinsically related to the hospital system compared to an external vendor may provide quicker telestroke services and improve DTN.