Abstract TP311: Organizational Culture Drives Confidence in Implementing Telestroke Care

Abstract

Background: In its first 18 months, the VA National Telestroke Program (NTSP) conducted 800 consults at 30 sites. Data from staff at participating sites are collected in anonymous surveys. We aimed to determine factors associated with confidence in providing stroke care at these sites, and whether confidence is associated with performance on NTSP quality indicators. Methods: Surveys were sent to providers at participating sites at baseline (BL) and 6 - 12 months post-NTSP implementation (post-I). Survey questions included items about confidence providing stroke care and items from the Organizational Readiness to Change Assessment (ORCA). Confidence (0-10) was dichotomized into fully confident (mean score of 10) and not fully confident sites (mean <10). ORCA score was averaged by site. Covariates included site performance, volume, and time in the NTSP. We used a Kruskal Wallis analysis to examine the association of BL variables with post-I confidence, and a Pearson correlation test to examine the association between performance indicators and confidence. Results: 16 sites, with 54 staff members total responding (57% nurses, 26% providers, 17% administrators/other), had BL and post-I data. Five sites were fully confident at the post-I assessment, the remaining 11 had mean confidence scores 8.32 - 9.5. Site confidence improved over time (mean 7.97 at BL vs. 9.44 post-I, p = 0.004), but confidence was not associated with site performance on any NTSP indicator. Higher ORCA scores were significantly associated with post-I confidence (mean ORCA 4.46 vs. 4.01, p=0.04). Fully confident sites also had shorter NTSP participation times (mean 5.40 months in the fully confident sites vs. 13.45, P=0.01). BL confidence, rurality, and consultation volume were not associated with post-I confidence. Periodic retraining was the most commonly suggested program addition. Conclusions: Organizational culture, but not performance or consult volume, is significantly associated with staff confidence in providing stroke care via telestroke. The finding that less confident sites have longer participation times suggests that planned retraining should be a part of telestroke programs to help sustain site confidence in providing stroke care.