Abstract P160: Characteristics of Telestroke Using Emergency Departments in a National Sample

Abstract

Background: Most data on spoke emergency departments (EDs) using telestroke come from single academic hub-and-spoke networks. Our objective was to describe characteristics of EDs using telestroke in a national sample. Methods: We surveyed a convenience sample of 366 EDs among those who self-identified as using telestroke on the 2016 National ED Inventory (NEDI)-USA, which goes to all US EDs. Surveys were mailed to ED directors, with follow-up phone calls to non-responders. The survey characterized ED staffing, transfer patterns, in-person consultant availability, alteplase use, and frequency of telestroke consultations. Descriptive statistics are reported. Results: Of the 4,410 EDs responding to the NEDI-USA telemedicine question, 1,824 (41%) reported using telestroke. Compared to non-surveyed telestroke EDs (n=1458), the 366 surveyed EDs had lower annual ED visit volume, and were more often rural and critical access hospitals. Of these, 320 (91%) affirmed use of telestroke on our secondary survey. Many were rural (n=157, 49%); few were academic (n=4, 1%). Only 132 EDs (41%) reported that > 80% of attending physicians were board certified or board eligible in emergency medicine. Joint Commission Stroke Center certification was reported by 101 EDs (32%) and alternative certification by another 53 (17%). Fifty-two EDs (16%) reported availability of an in-person neurologist, with 32 (10%) available within 30 minutes, and 29 (9%) available 24/7. Frequency of telestroke consultation varied (Figure). Most EDs administered alteplase in the past year (n=261, 82%); some reported alteplase administration without telestroke consultation (n=94, 30%). EDs frequently admitted TIA and stroke patients without thrombolysis (78% and 55% respectively), but fewer (24%) admitted alteplase-treated patients. Conclusions: Telestroke is frequently used in US EDs. Of those surveyed, many had non-emergency medicine attending staffing and use the technology regularly.