Introduction: Telemedicine is widely used for remote evaluation and treatment of acute stroke patients (telestroke). Because time equals brain, the NINDS and ACLS recommend a benchmark of 15 minutes from arrival to neurologic expertise. Our goal was to examine key time metrics and outcomes in an active telestroke network after implementing system-wide improvements.
Methods: Our comprehensive stroke center (CSC) serves as the Rocky Mountain Region’s referral center for comprehensive stroke care. The telestroke program launched in 2006; stroke program leaders recently initiated several changes to improve time metrics, including a) a streamlined process for the centralized call center including centralized paging; b) a dedicated, on-call telestroke neurologist; c) outreach and education to the spoke hospitals for accessing the call center; d) back-up systems in place for technical issues and for times of high consult volumes. We examined the following metrics for all telestroke consults compared to patients admitted through the ED of the CSC over the past 18 months: median (interquartile range [IQR]) neurologist response time, transfer rate to the CSC, and IV t-PA rate. Median telestroke consult times (time to initiation of video consultation) were also reported, beginning April 2016.
Results: Ten neurologists at the hub CSC responded to 4,283 pages from 45 spoke hospitals, averaging 8 pages/day. Overall, 14.4% of patients were transferred to the CSC for definitive care. The time to telestroke page response was 2 [1-3] minutes, which was comparable to neurologist response at the CSC of 0 [0-5] minutes for 686 patients. The median telestroke consult time was 2 [1-4] minutes for 70 patients. The IV tPA rate for treating acute ischemic stroke was comparable for telestroke vs. bedside consults (17.3% vs. 18.9%).
Conclusions: Based on our mature telestroke network, it is possible to be as responsive with telestroke consults as with in-hospital consults. Several new, scalable processes resulted in improved time metrics. These time metrics should help define what should be expected from a Telestroke provider.