Abstract W P193: Early Involvement of Stroke Neurologist Allows Efficient Tissue Plasminogen Activator Administration in Member Hospitals of a Telemedicine Network

Abstract

The Michigan Stroke Network provides telestroke services at 32 hospitals across Michigan. These include several critical access hospitals and free standing emergency rooms (ERs). The network conducts ongoing education of member hospitals, emphasizing rapid recognition of symptoms and early activation of the stroke network. Our hypothesis was that prompt communication with a stroke neurologist will facilitate processes and decision making; reducing door to needle times for patients receiving tPA Methods: Data was collected for all video consultations. For patients who received tPA, time of symptom onset, time of arrival at member hospital, time of call to network and door to needle times were recorded. Data from January 2012-March 2013 are presented in this abstract; further prospective data collection is ongoing. Results: Over 15 months, 249 consultations were performed, resulting in 42(16.8%) tPA administrations and 110(44.2%) transfers for endovascular therapy or post tPA care. A door to needle time<60 min was achieved in 17 of 42(40.4%). Three patients received tPA for symptoms starting within the hospital. Of 33 patients who arrived within 2 hours of symptom onset, 27(81.8%) received tPA within 3 hours. When the stroke network was activated within 20min of patient arrival, 9/10 patients received tPA within 60 min; whereas if the network was not activated within 20min, only 8/29 achieved this target(p=0.0009). In conclusion, involving the on-call neurologist in a telemedicine network facilitates early decision making and results in shorter door to needle times. Quality improvement initiatives within a hospital network should concentrate on improving front end processes for early identification of stroke symptoms and prompt communication with the stroke neurologist.