Abstract 34: Achieving a 30 Minute Door to Needle Time in a Primary Stroke Center via Telestroke

Abstract

Background: Despite efforts made within the Emergency Department (ED), delays in the administration of thrombolytic time via telestroke remain. A Primary Stroke Center (PSC) aimed to reduce door-to-needle time (DTN) by focusing on ED, EMS, CT and physician staff regarding: door-to-CT process, importance of time goals, IV thrombolysis, and early activation of Telestroke. Methods: A retrospective analysis examined patients who arrived to a PSC and received a telestroke consult in the ED from January 2020 to June 2023. A change in the stroke alert process (January 2023) focused on early notification of stroke alert, CT and telestroke. Thus we compared data from prior to the change in process (January 2020 - December 2022) to after changing the process (January 2023 - June 2023). Primary outcome was a comparison of door-to-needle time (DTN) before and after changing the stroke alert process which was analyzed using a quantile regression specifying the median. Secondary outcomes included: DTN goals within 30, 45, 60 minutes and proportion of IV thrombolysis utilizing hierarchical binomial logistic regressions. Additional outcomes were door-to-CT head (DTCT) and door-to-telestroke (DTSR) analyzed via median regression adjusted for age, NIHSS and arrival modality. All outcomes were adjusted for age, NIHSS and arrival modality (EMS versus private vehicle). Results: Overall 1160 ED telestroke consults occurred the study, with a mean age ± SD of 68.75 ± 15.48. There were 989 consults before and 171 consults after the process change. After changing the ED stroke process, there was a reduction in DTN of 29.26 minutes [95% Confidence Interval (CI), 17.45 - 41.08], p < 0.0001. DTN goals of 30, 45 and 60 minutes were met more often after the change compared to prior, all adjusted p < 0.005. A higher proportion of IV thrombolysis rates occurred after the process change [21 (12.3%) versus 79 (8.0%)], adjusted Odds Ratio (aOR) = 2.18 [95%CI 1.27 - 3.75], p = 0.005. There were significant reductions in DTCT and DTSR after changing the process, all p < 0.001. Conclusion: A standardized workflow with emphasis on early stroke alert and CT resulted in a significant reduction of DTN, and allowed a PSC with telestroke to consistently achieve DTN < 30 minutes.