Abstract 118: Expanded Tele-stroke Coverage In Community Hospitals Improves Care For Stroke Patients And Reduces Transfers

Abstract

Background: Minor ischemic strokes and transient ischemic attacks account for more than a third of ER stroke admissions (21% and 15%, respectively). Most small community hospitals lack adequate coverage by stroke service necessitating transfer of stroke patients to comprehensive stroke centers. Methods: We studied the effect of implementing telestroke service in all regional hospitals and emergency departments affiliated with Promedica Toledo Hospital, a comprehensive stroke center (CSC). This service is carried out by stroke-trained advanced practice providers under supervision of vascular neurologists. Coverage included acute ED assessments of stroke patients, inpatient telestroke consults and follow ups. We propose that this comprehensive telestroke service will improve care of stroke patients presenting to community hospitals, decrease the number of transfers to CSC. It will improve numbers and timing of IV thrombolysis. Results: The total stroke alerts from affiliated locations before implementing telestroke service (2018 and 2019 and first half of 2020), and after implementing the service (since July 2020, 2021, and 2022) were 4817 and 4900, respectively. In pre-telestroke years, about 43% of patients were transferred to the CSC for acute stroke care while during post-telestroke years were 28% with 34.8% reduction on transfers. Among transferred patients, stroke mimickers' percentage decreased from 21% to 8%. There was a 14.5% increase in the number of IVT patients after implementing telestroke service but door to needle time did not change. Conclusion: This is the first reported experience of utilizing stroke-trained APPs to expand telestroke coverage for both ED and inpatient services at community hospitals. There was a decrease in number of transfers to CSC, keeping patients at their local communities. It also increased the number of IV thrombolytic treatments and reduced the number of stroke mimickers' transfers.