Abstract TP99: Implementing Telestroke in the Inpatient Setting: Identifying Factors for Success

Abstract

Background: Inpatient telestroke programs have emerged as a solution to provide timely stroke care in underserved areas, but their successful implementation and factors influencing their effectiveness remain underexplored. This study aimed to qualitatively evaluate the perspectives of inpatient clinicians located at the spoke hospital who were participating in a newly established inpatient telestroke program in order to identify implementation barriers and facilitators. Methods: This was a formative evaluation relying on semi-structured qualitative interviews with sixteen inpatient providers (physicians and nurse practitioners) that have utilized inpatient telestroke services. Interviews were conducted with providers at spoke sites of a hub-and-spoke inpatient telestroke program. The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided data analysis, focusing on the innovation, recipients, context, and facilitation aspects of implementation. Interviews were transcribed and coded using thematic analysis. Results: Fifteen themes were identified in the data and mapped to the i-PARIHS framework. Themes related to the innovation (telestroke program) included easy access to stroke specialists, the benefits of limiting patient transfers, concerns about duplicating tests, and challenges of timing inpatient telestroke visits and notes to align with discharge workflow. Themes pertaining to recipients (care team members and patients) were communication gaps between teams, concern about the supervision of advanced practice providers, and challenges with nurse empowerment. With regards to the context (hospital and system factors), providers highlighted familiarity with telehealth technologies as a facilitator to implementing inpatient telestroke, yet highlighted resource limitations in smaller facilities. Facilitation (program implementation) was recognized as crucial for education, standardization, and buy-in. Conclusion: This study identified barriers and facilitators in launching an inpatient telestroke program within a health system, highlighting the importance of leveraging facilitators and addressing barriers for effective implementation and continuity.