Introduction: Door-to-needle time (DTN) is a primary metric of operational success in the provision of thrombolytic therapy in cases of acute ischemic stroke (AIS). A telemedicine provider and a multihospital system collaborated to improve notification of the need for consultation by introducing an online consult request system for teleneurology consultations. A simplified user interface allowed for notification from any device with an active Internet connection, and provided user capability with minimal training.
Hypothesis: An online directed consult request system will reduce DTN.
Methods: This observational study assessed changes in DTN before and after institution of an updated consult process. Prior to institution of the process change all consults were identified through a phone call to a consult coordination center with required information as part of the interaction. After the process change all acute stroke consults were requested through on online automated methodology. Sample mean DTN times among thrombolytic cases were compared using one-way ANOVA. Other related variables are reported.
Results: Five hospitals in a single hospital system participated in the conversion from the original to the updated communications method, with staggered conversion dates. The sample includes 220 total cases pre-conversion and 128 total cases post-conversion over a total time of 18 months. Among thrombolytic cases, the DTN pre-conversion was 65.3 minutes and 51.3 minutes post-conversion (p=0.0003). There were no significant differences among the samples related to age, gender, NIHSS or other premorbid conditions. There were no significant differences found related to length of stay (LOS) or disposition.
Conclusion: The study demonstrates a significant and immediate effect on DTN related to an isolated change in the methodology of consult request between a hospital system and a telemedicine provider. Future study will examine effects on clinical outcome, LOS, and financial performance.