Background and Purpose: Some facilities are not fully equipped to manage acute stroke patients including administration of tPA. Therefore, telemedicine has played a vital role in filling this void. Telemedicine provides remote consultative support via an interactive encounter including virtual examination, telemedicine assessment, and, remote diagnosis and treatment decision-making. Telemedicine in stroke care has the been shown to increase use of tPA and decrease delays in diagnosis and treatment. Team collaboration between two facilities, part of a large healthcare system, resulted in changes to stroke telemedicine structure and processes transiting from a national network of specialists to utilization of facility #2’s neurology staff with a focus on a nurse responder. The focus of the nurse responder was assessment and facilitation of the acute diagnostic and treatment processes. Nurses received enhanced education on telemedicine technology. Building relationships across the two facilities within a telemedicine culture was key in successful development, implementation, and evaluation of service changes. The purpose of this study was to compare stroke outcome metrics pre and post implementation of a standardized telemedicine service.
Methods: A retrospective, pre and post design was used in conducting a chart review comparing 2014 pre-implementation data with 2015-2016 post-implementation data on the number of patients who received tPA and door-to-needle times.
Results: The number of patients who received tPA at facility #1 increased from 25 cases to 27 in the first year after implementation of standardized telemedicine services and 39 cases the 2nd year. Door-to-needle time significantly decreased from a mean of 131 minutes to 76 minutes (t(18)=2.472, p<0.038) the 1st year and 62 minutes (t(20)=3.381, p<0.004) the 2nd year. The decrease in door-to-needle time from the 1st and 2nd year is significant (t(18)=1.684, p<0.031).
Conclusions: Standardization of telemedicine services for acute stroke care and utilization of nurse responders, who provide timely assessments and facilitation of stroke care processes within a collaborative telemedicine culture, can result in significant improvements in utilization and delivery of tPA.