Ideal telestroke time targets: Telestroke-based treatment times in the United States stroke belt

Abstract

Background Studying critical time interval requirements can enhance thrombolytic treatment for stroke patients in telestroke networks. We retrospectively examined 12 concurrent months of targeted time interval information in the South Central US telemedicine programme, Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES). Hypothesis: We hypothesised that consult data analysis would highlight areas for improvement to shorten overall door to Intra venous (IV) tissue plasminogen activator (tPA) administration time. Methods We analysed critical time targets for 238 consecutive telestroke neurology consults obtained over 12 months from AR SAVES spoke sites when tPA was administered. The following time intervals were analysed: emergency department (ED) door to Computed Tomography (D-CT); ED door to call centre (D-CC) for initiation of consult; ED door to neurology call (D-NC); neurology call to camera (NC-Cam); tele consult time (Con); ED door to tissue plasminogen activator (tPA)/needle (DTN). Results The median times of D-CT (13 min, inter quartile range (IQR) 6–22 min), D-CC (34 min, IQR 20–45 min), D-NC (40 min, IQR 21–71 min), NC-Cam (4 min, IQR 2–8 min), and Con (25 min, IQR 17–37 min) all contributed to a DTN median time of 71 min (IQR 50–104 min). A total of 238 patients received tPA with a 29.4% treatment rate and a DTN time of ≤60 min was achieved in 25.2% of patients. Conclusions Focusing on reducing D-CC and Con times may help to achieve the DTN time of < 60 min for the majority of patients. Having ideal time targets for telestroke patients akin to traditional patients will help identify and improve the overall goal of a DTN time < 60 min.

Why are acute ischemic stroke patients not receiving thrombolysis in a telestroke network?

“…This is a continued impediment for IV tPA administration. 6,28,29,33 Several strategies including pre-hospital notification, [34][35][36] utilization of modified stroke scales for paramedics, 37,38 setting up of telestroke units in rural areas 14,23,39 and public stroke education have been employed to tackle this problem. However, late presentation still is one the most common factors limiting the eligibility for IV tPA in stroke patients.…”

“…12 Telestroke practice has led to significant improvement in stroke care around the world [13][14][15][16][17][18][19][20] with evolving guidelines for telestroke practice. [21][22][23] Given the improvement in stroke care by telestroke networks, we wanted to explore the most common reasons for not getting IV tPA in telestroke care, which might be useful to improve treatment rates in future.…”

Establishing a digital health platform in an academic medical center supporting rural communities

“…The purpose was to improve transport times to medical facilities qualified for stroke care and, as a result, to decrease time to treat. Two primary arms of the program are (1) development of telestroke centers in rural hospitals and (2) provision of information on qualified stroke centers to emergency services paramedics transporting patients [21][22][23]. Its success is reflected in the approximately 2000 patients treated, a treatment rate increase of >30%, and improved transport times to qualified stroke centers [21,24].…”

Telestroke: A New Paradigm

“…It has been shown that D-NC and Con play a major role in DTN [90]. Various factors including, when the consultant is notified, the time a consultant takes to interview the patient, and the experience level of the staff aiding with the examination will have to be considered while analyzing such data.…”