Abstract T P194: Clinical Use of Telemedicine for Acute Stroke Care in a Regional Area: Findings From the Victorian Stroke Telemedicine (VST) Project

Abstract

Background: Telemedicine systems can facilitate evidence-based care for patients with stroke, but are rarely used in rural Australia. Objective: We assessed the hypothesis that a stroke telemedicine program could increase stroke thrombolysis and improve the timeliness of diagnosis and investigation of stroke. Methods: The finalised Victorian Stroke Telemedicine (VST) protocol was implemented at one site in regional Australia from October 2011 to October 2012. All patients who present to the Emergency Department (ED) within 4.5 hours of stroke onset, who were aged 18 years or older, and had suspected stroke symptoms, were eligible for a telemedicine consultation. Clinical data was collected for stroke patients who presented within 4.5 hours of symptom onset one year prior to implementation (baseline) and during the one year VST implementation phase. Results: For all admitted strokes during VST (October 2011 - October 2012), stroke thrombolysis increased from 8% to 13% compared to pre-VST data. For those patients who arrive to the ED within 4.5 hours, analysis was based on small groups (baseline n=58; VST n=62), which limited ability to detect statistically significant results. However, there was evidence of clinically important trends, such as a 29 minute reduction in door-to-CT scan from baseline [median 63, IQR 29-103] to VST [34, IQR 20-58, p=.006]. Stroke onset-to-needle time was quicker by 45 minutes after VST implementation [173, IQR 148-234, p=.108]. There was a 21% reduction in hospital transfers (p<0.005). Overall, it was estimated that there was a reduction in three years of disability adjusted life years (DALY’s) for thrombolysed patients. Conclusion: The VST program has enhanced thrombolysis delivery and timeliness of associated clinical investigations and decisions in a regional emergency department.