Abstract 79: Long-term Patterns Of Patient Transfer In A Regional Telestroke Network

Abstract

Background: Telestroke has been increasingly adopted by hospitals with limited access to neurological expertise and is often followed by transfer for a higher level of care. We sought to characterize factors independently associated with patient transfers after telestroke consultation in our regional telestroke network. Methods: We studied all telestroke consults from our urban comprehensive stroke center from 1/1/2005 to 06/30/2022 using the records in our telehealth portal. We examined the annual proportion of transfers among all consults overall and stratified by 6 levels of NIHSS severity and 4 levels of spoke hospital rurality. We used generalized linear mixed models to evaluate the association between transfer and patient demographics, hospital characteristics, use of video and care quality metrics (timeliness and tPA use), accounting for clustering by spoke hospital. Results: We identified 20,618 consecutive telestroke consults, of which 5,276 (25.6%) were transferred (602 cases excluded with unknown transfer status). The proportion of transfers decreased significantly over the study period (Figure). Decreases were observed for all rurality strata and all but the most severe strokes. After adjusting for temporal trends, factors independently associated with transfer included younger age, male gender, more severe stroke, and tPA use (Table). Conclusion: In our regional telestroke network, the proportion of transfers decreased substantially from 2005 to 2022 overall and across almost all patient and hospital groups. Telestroke may facilitate capacity management and retaining care in lower cost community settings, which may increase healthcare value.