Introduction: Telestroke can improve access to experts at smaller hospitals to assist with thrombolysis decision making. We trialled a regional telestroke ‘hub’ and ‘spoke’ model that was associated with a substantial increase in thrombolysis rates at ‘spoke’ hospitals. One ‘spoke’ hospital, however, elected to discontinue the telestroke service and returned to providing thrombolysis solely under the guidance of local general physicians. The rationale being that the transient telestroke service helped to upskill local doctors and that the boost in rate was partially or even mainly due to other changes in the local services.
Methods: This is a sequential comparison of three periods: 6 months pre-telestroke, 6-months during telestroke, and 6-months post telestroke. Main outcomes were thrombolysis rate and door-to-needle time with versus without telestroke support.
Results: Over the 18-month period, 25 patients of 195 admitted ischemic stroke patients were thrombolyzed at this small centre. The thromboloysis rate was 8.5% (6/71) during the 6-months pre, 23.0% (14/61) during the 6-months of, and 7.9% (5/63) during the 6-months post the use of telestroke support from the tertiary centre (with telestroke odds (95% CI) of being thrombolyzed 3.33 (1.41-7.86); p=0.006). Patients receiving thrombolysis within 60 minutes of arrival were 50% before, 64% during, and 20% after telestroke (with telestroke OR (95%CI) 3.15 (0.61-16.3); p=0.16). Careful review of patients not treated after discontinuation of telestroke revealed that nine additional patients would have likely been treated had a stroke specialist been involved in the decision-making process raising treatment rate to 22% (14/63).
Conclusion: These finding indicate that the transient implementation of telestroke was insufficient to upskill provincial hospital generalist clinicians to sustain a high thrombolysis rate. It also supports the conclusion that telestroke itself contributed strongly to the increase in treatment rate rather than the rate increase being primarily attributable to other factors. The numbers are small and need to be interpreted with caution. However, interestingly, the rates at centres who have opted to continue with telestroke have been maintained at the much higher level.