Abstract TP270: When Telestroke Programs Work, Bed Size Really Doesn’t Matter

Abstract

Background: Telestroke rural networks are comprised of micro>small>medium>large sized hospitals without specialized neurology support. Many times the micro hospitals are < 25 beds. In an examination of spoke hospitals in the Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) telestroke program, we determined program efficacy correlating bed number. Efficacy was determined by the mean Door-to-ED physician (D2MD) time and door-to-needle (D2N) Alteplase time, and numbers of Alteplase administrations (#Alteplase), mock scenario sessions (#Mocks) and consults (#Consults). Hypothesis: All hospitals would perform equally well with the larger hospitals with slight tendencies to outperform the smaller hospital sites in the #Consults and #Alteplase. Methods: We retrospectively reviewed 2015-2017 spoke hospital data from AR SAVES, the largest statewide telestroke program. The #Mocks and #beds were comparatively analyzed using regression analysis for D2MD, D2N, #Consults and #Alteplase. Spoke sites were categorized by bed numbers; 0-25, 26-50, 51-100, 101-150, 151-200 and > 200. Results: Data from 53 spokes encompassing 2,555 consults over three years indicated that sites > 151 beds were significantly higher in #Alteplase (p < 0.01) and #Consults (p < 0.002). Although the #Mocks were not different among the smaller vs. larger hospitals (p > 0.19), nor was the D2MD time (p=0.82). However, the hospitals < 50 beds had significantly shorter D2N mean time (p < 0.03). The micro (0-25 beds) vs the largest hospitals ( > 200 beds) D2N mean times, were significantly less (76.0±2.5 vs 87.5±4.0 min, p=0.01, respectively). Conclusions: Although the smaller hospitals receive less volume of consults and #Alteplase, with training they perform equally if not better than their larger counterparts.

Telestroke: A New Paradigm

“…Studies have shown that telestroke facilitated administration of tPA to patients in community hospitals and rural hospitals (as small as 100 beds or less) has outcomes comparable to those of in-person treatment at comprehensive stroke care centers [58][59][60][61]. Even with in a stroke network, the performance of spoke sites is similar regardless of the bedsize [62]. Also, the use of telestroke at rural hospitals can provide patients with comparable or reduced time between symptom onset and tPA administration [door-to-needle time (DTN)] compared to those directly presenting to tertiary care centers [63].…”

“…Most of the measures are already being performed with a high compliance rate and innovation. They should be expanded to pre-hospitalization and post-hospitalization settings as well as to telestroke for further improvement of stroke care [62,[96][97][98][99]. Universal guidelines about definitions of times in stroke chain-of-care, protocols for consultant notification, and specific standard stepwise processes that can be applied universally for telestroke networks will be useful in standardizing telestroke models.…”