Abstract
Background: Telestroke increases tPA use at spoke hospitals, yet its effect on door-to-needle (DTN) times is unknown. More frequent use of telestroke may introduce delays in DTN time or may improve it as practice leads to streamlined processes. Hypothesis: We hypothesize that spoke hospitals with more frequent contact to a hub hospital will have shorter DTN times than those with less frequent contact. Methods: We identified 367 patients treated with tPA by conventional or telestroke methods in the MGH Telestroke network for whom date and time data were available. Strength of the spoke-MGH connection was the primary predictor variable, defined as the number of all telestroke consults (tPA and non-tPA) done at each spoke hospital during the year of the patient’s presentation. Patient-level regression analyses examined the relationship between DTN time and spoke-MGH connection. We controlled for hospitals’ tPA volume, temporal trends, and clustering within hospitals. Results: Sixteen spoke hospitals contributed data on 367 tPA-treated patients from 2006-2016. Hospitals treated a median of 12.5 patients with tPA (IQR 7-33.5). Median hospital-level DTN was 78.8 minutes (IQR 71.3-85). Median number of telestroke consults per year was 37 (IQR 15-60). Among all 367 patients, median DTN was 76 minutes (IQR 61-98), and 24.8% of patients were treated within 60 minutes (n=91). Strength of connection between the spoke and hub hospital was significantly associated with faster DTN time for patients (1.8 minute gain per 10 additional consults, p<0.001) and increased likelihood of tPA delivery within 60 minutes (OR 1.01, p<0.001). Conclusion: More frequent contact between a telestroke spoke and its hub was associated with faster tPA delivery for patients, even after accounting for hospitals’ tPA volume and secular trends in DTN improvements. This highlights added benefits of increased utilization of telestroke.
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