Background: Through application of the American Stroke Association Target Stroke Best Practice Strategies, our telestroke program led by internal medicine has dramatically improved door-to-needle (DTN) time for thrombolysis. However, a persistent delay was noted in the time interval between patient arrival and on-screen evaluation by a teleneurologist. We collaborated with a telestroke vendor on a pilot project, “SpeedPass”, in order to reduce the delay.
Methods: In the “SpeedPass” pilot project, initiation of teleneurology consultation was converted from a traditional phone process to an online format. SpeedPass was applied to all patients presenting to the hospital with acute ischemic stroke symptoms within the window period for thrombolysis. The online format was completed by a senior internal medicine resident or an attending physician with specific information such as patient identification, arrival time to the emergency room, last well known well time and use of an anticoagulant. Retrospective chart review was performed comparing Door-to-Video (DTV) and Consultation-to-Video (CTV) times between the pre-implementation period (1/1/15-12/31/15) and post-implementation period (1/1/16-4/30/17).
Results: Data on a total of 47 patients who received thrombolysis was compared. Mean DTV time decreased from 31.86 minutes in the pre-implementation group to 23.96 minutes in the post-implementation group. Mean CTV time decreased from 22.31 minutes to 9.92 minutes respectively. In the pre-implementation group, 6 of 22 patients (27.3%) received thrombolysis within 45 minutes compared to 12 of 25 patients (48%) in the post-implementation group.
Conclusion: Our streamlined collaborative approach with SpeedPass has significantly reduced triage and teleneurology consultation time. The reduction in CTV and DTV time has resulted in a greater percentage of qualified patients receiving thrombolysis within 45 minutes and being transferred to a comprehensive stroke center. Similar measures could benefit rural and community hospitals that lack 24/7 in-house neurology coverage.