Background: The implementation of Telestroke systems has made stroke expertise accessible to patients evaluated in hospitals located in rural areas. Yet, decreasing time from emergency department (ED) arrival to administration of intravenous tPA is still a challenge in many rural hospitals. Stroke coordinators can provide staff training on stroke recognition and implement strategies for faster assessment of acute stroke patients. We sought to determine if the presence of a stroke coordinator (SC) at Telestroke sites contributed to decreased door-to-registration (DTR) and door-to-needle (DTN) time in the ED.
Methods: Data from Telestroke consultations at 22 different community hospitals in South Carolina (2008 - 2016) were analyzed. DTR and DTN were compared between consults when a SC was employed or not at the respective hospitals at the time of the consultation. T-tests and chi squared were used to examine differences in continuous and categorical variables, respectively. Estimates for each outcome were determined using a log link general linear model, with a gamma distribution, adjusting for patient age, sex, site, and stroke severity (NIH stroke scale) on admission.
Results: Of 8441 Telestroke consultations performed, 5842 (69%) were included in the DTR analysis, with the remainder excluded due to incomplete data. DTN was available for 1056 consultations. Adjusted mean DTR time was 23.3 minutes shorter (31.6 vs. 54.9, p≤0.001) for consultations in sites that employ a SC vs. those without. Mean DTN time was 29.7 minutes shorter in sites with a SC (64.5 vs. 94.2, p≤0.001). The multivariable analysis showed that employment of a SC, site, patient age and NIHSS were significantly related to shorter DTR and DTN.
Conclusions: Employment of a stroke coordinator at remote hospitals receiving Telestroke services can significantly decrease time to registration and time to treatment of patients presenting with acute stroke symptoms, which may improve outcomes for stroke patients.