Abstract TP389: Collaborative Approach to Improving Tele Stroke Call Back Times

Abstract

Background/Purpose: Emergency stroke evaluation requires rapid access to stroke experts for treatment decisions and advice, in many community settings this is facilitated through a hub and spoke telemedicine relationship. Since widespread adoption of the expanded endovascular time window, volume of calls to a single large academic hub stroke center have drastically increased and it was identified that there was a delay in achieving rapid connection to the hub sites which may result in delayed tPA evaluations. We sought to implement a focused process review to improve timely access to the hub stroke team. Methods: Leadership from the hub and spoke hospitals collaboratively reviewed and implemented steps to improve the time from spoke call out to hub call back for acute stroke. Interventions included: 1) Establishing a goal of less than 10 minutes for physician contact on all cases, 2) Revising spoke protocol to call out immediately following CT instead of after CT read, 3) Development of a stroke call out log that is shared between sites, 4) Hub hospital revised protocol to have cases within tPA time window bypass phone call and go directly to camera, 5) Exchange of direct cell phone numbers for follow-up questions on existing patients, 6) Weekly calls to discuss any video case time delays and time flow review, 7) development of a hub hospital call center escalation process for when the primary call physician has multiple calls coming in. Results: Data we analyzed through retrospective review of a prospectively collected database over a five month period. Results are displayed in the table 1. Conclusions: Improved process flow times within tele-stroke networks may be achieved through a focused collaborative relationship between hub and spoke hospitals with transparency of data and open discussion about barriers to achieving desired results.