Abstract TP222: Improving the Quality of Acute Stroke Care in regional Australia: The Victorian Stroke Telemedicine Program

Abstract

Background: The Victorian Stroke Telemedicine (VST) program is the largest stroke telemedicine service operating in Australia. Patients and clinicians at 16 regional hospitals in Victoria are provided with 24/7/365 access to a network of on-call metropolitan-based neurologists via telemedicine. The VST program supports rapid differential diagnosis and enhances access to best-practice treatments for acute stroke, including transfer to comprehensive stroke centres for endovascular clot retrieval (ECR). Method: A historical-controlled cohort design was used to evaluate the VST Program. At each hospital, consecutive patient-level data were obtained 12 months before the VST program commenced (pre) and during the first 12 months of implementing the program (post). Basic clinical data were collected for patients aged 18 years or more and arriving in the Emergency Department (ED) with suspected stroke. Detailed data collection on the patient journey in hospital was conducted for patients with a confirmed ischemic stroke who arrived within 4.5 hours of symptom onset. Aggregated descriptive statistics using the available data for 16 hospitals are presented. Results: Overall, 6099 patients with suspected stroke (2932 pre, 3167 post) have presented up to 28/7/2017. Patients arriving to ED within 4.5 hours of ischemic stroke symptom onset: pre-VST n=358 (54% male; mean age 74 years) and post-VST n=484 (59% male, median age 76 years). The proportion of patients meeting these criteria who received intravenous thrombolysis increased (pre: 30% to post: 38%, p=0.019). The median door-to-needle time was faster (pre: 103 minutes; post: 72 minutes, p<0.001), and more patients received thrombolysis within 60 minutes of arrival (pre: 14%; post: 32%, p<0.001). Symptomatic intracerebral hemorrhage after thrombolysis was reduced (pre: 16%; post: 5%, p=0.002). Since the availability of ECR in May 2015, 25% of cases receiving thrombolysis were transferred for ECR. Conclusion: Telemedicine expedites access to optimal stroke care and immediately facilitated access to the newest intervention, ECR, with more patients safely and efficiently treated.