Abstract 80: Predictors of Door-to-Needle Time in the Veterans Health Administration National Telestroke Program

Abstract

Introduction: The Veterans Administration (VA) National Telestroke Program (NTSP) increases access to stroke specialists across the VA enterprise. Unlike most telestroke networks, VA hospitals are not integrated into a hub-and-spoke model and most Veterans present to VA emergency departments by personal vehicle, rather than emergency medical services (EMS). Predictors of Door-To-Needle (DTN) time in Veterans receiving tPA via telestroke may differ from community telestroke systems. Methods: A logistic regression model was applied using operations data to identify patient and hospital characteristics predictive of DTN times < 60 minutes. Predictors variables included patient demographics, National Institute of Health Stroke Scale score, Last Known Well time on arrival, rurality, integration with EMS routing systems, local neurology service, VA-designated facility complexity status, time from arrival to CT and time from CT to treatment. Results: Among (N=448) Veterans treated via Telestroke from 2017 to 2022, 32% (n=142) received tPA < 60 minutes. No significant differences were observed between groups in terms of patient characteristics (Table). Significant differences were seen in hospital characteristics of complexity status (p=0.013), time from arrival to CT (p<0.001), and time from CT to treatment (p<0.001). The odds of receiving tPA < 60 minutes were 12.4 times greater for patients with a door to CT time of < 10 minutes (95% CI 6.7, 23.2) and 28.5 times greater for patients with a CT to treatment time < 40 minutes (95% CI 14.5, 56.5). Conclusions: Our data clearly demonstrate that achieving target times of < 10 minutes for arrival to CT and < 40 minutes for CT to treatment increases the odds of receiving tPA in < 60 minutes. This finding underscores the importance of improving stroke systems within VA hospitals to facilitate these key target times.