Abstract NS5: A Telestroke Nurse/Neuroradiologist Model For Extended Window Code Stroke Triage

Abstract

Background and Purpose: Two distinguishing features of our stroke network include the routine involvement of a telestroke nurse (TSRN) for code stroke activations at non-thrombectomy centers, and immediate availability of neuroradiologist for imaging interpretation. With revascularization treatment decision making for patients presenting beyond 4.5 hours from last known well (LKW) being driven by imaging, we hypothesized that reliance on those resources could substantially decrease the routine involvement of a teleneurologist. Methods: On May 1, 2021, we implemented a workflow for code stroke activations beyond 4.5 hours from LKW that relied on a TSRN supported by a neuroradiologist. Criteria for a code stroke activation included any cortical sign on exam or suspicion for a basilar artery occlusion, as determined by the treating Emergency Medicine (EM) physician. All qualifying patients underwent a CTA with or without CTP imaging. Patients with a target occlusion on CTA confirmed by the neuroradiologist, the neurointerventionalist and neurologist at the thrombectomy center are immediately contacted to join the triaging team. Patients without a target occlusion on CTA are managed without the involvement of a teleneurologist, unless requested by the treating EM physician. Results: In our first 3 months utilizing this workflow, there were 509 extended window code stroke activations. In 64% (n=326) of these cases, a teleneurologist was not initially involved, representing a cumulative 58% absolute decrease in teleneurology consultations when compared to the prior three months. For 95% (n=311) of those cases, a target LVO was not identified. For the 15 LVO cases, the median CTA acquisition to LVO confirmation time was 14 minutes (IQR 11-25.5). Ninety-five percent (n=311) of non-LVO cases were subsequently managed by the EM physician. Of those cases, 90% (n=292) were admitted to the hospital. For 47% (n=138) of admitted cases, the patient had a non-stroke diagnosis. Thirty-nine percent (n=114) of all admitted cases were managed by a hospitalist physician without a neurology consult. Conclusions: A telestroke nurse/neuroradiologist model for extended window code stroke triage can substantially reduce the routine involvement of a teleneurologist.