Abstract WMP30: How To Beat The Metrics With Telestroke: A Community Hospital Primary Stroke Center Experience

Abstract

Background and Issues: A community hospital primary stroke center (PSC) faced many challenges including inconsistent local neurology coverage as well as inefficient in-hospital workflows. This led to a decrease in number of patients treated with IV thrombolytics, a decline in meeting stroke metrics, and challenges in maintaining PSC certification. Purpose: To implement a Telestroke system of care that would provide advanced acute stroke management in a community hospital with the goal of improved stroke workflows, stroke metrics, and quality of care. Methods: In 2019 a 172-bed community hospital PSC collaborated with a Telestroke program at a Comprehensive Stroke Center. This collaboration led to significant changes including ED physician leadership, standardized protocols with an increase in stroke alerts, EMS engagement, pre-mixing thrombolytics, dedicated stroke coordinator and education of all key personnel. The primary outcome measures were volume of stroke alerts, rate of thrombolytic use, and median door to needle before and after telemedicine implementation. Results: After one year of Telestroke utilization, the number of stroke alerts increased from 88 in 2018 to 256 in 2020 (290% increase). The number of patients receiving thrombolytics increased by 440% (10 in 2018 to 44 in 2020). Median door to needle time decreased from 56 mins in 2018 to 41 mins in 2020, an improvement of 15 minutes. Conclusions: Telestroke is a consistent and effective way to assess patients with suspected acute stroke in a community hospital setting. Key factors to its successful implementation include dedicated ED physician leadership, consistent protocol application, education and data sharing for motivation and continuous process improvement. In conclusion, Telestroke use increased access to stroke neurologists and improved thrombolysis rates and stroke outcomes.