Abstract WP234: Timeliness of Thrombolytic Therapy Using Telemedicine

Abstract

Background: Ischemic stroke guidelines recommend an arrival to treatment initiation time of ≤60 minutes. Recent national data suggest that fewer than one-third of patients treated with intravenous thrombolysis (tPA) had door-to-needle times (DTNT) ≤60 minutes. Telemedicine is a potential timesaving, efficient means for evaluating patients experiencing acute stroke. We evaluated our DTNT for our California telestroke network to determine if early access to a stroke neurologist improved the DTNT. Methods: We reviewed data on acute ischemic stroke patients treated with tPA within 3 hours of symptom onset for 18 California hospitals as part of the Specialists on Call (SOC) telemedicine network, a national, Joint Commission certified telehealth provider. Data from 2010-2012 were studied to determine the frequency and characteristics of patients treated with DTNT ≤60 minutes. Results: Among the 112 patients treated with tpa, 54% of patients were female, average age 70, median NIHSS 10 (interquartile range 5-18). DTNT was ≤60 minutes in 27.7% of patients evaluated. 10.1% of patients were treated in ≤70 minutes and 22.3% in ≤90 minutes. Consultants responded to consult request in <15 minutes but there was often a long delay between arrival and consult request. Mean door to consultation request time was 76 minutes. Mean time from consult start to tPA recommendation was 35 minutes. The proportion of patients with DTNT ≤60 minutes varied widely by hospital but there was a trend to faster DTNT in the 5 hospitals designated as Joint Commission certified Primary Stroke Centers. Conclusions: Telemedicine enables patients to be treated within time windows similar to that of national clinical practice with in-person response at facilities without access to a stroke neurologist. Shortening the door to consultation request time may help improve our DTNT. Our data correlate with national data in that less than one-third of patients treated with intravenous tPA had DTNT≤60 minutes. Telemedicine should be included as part of national stroke target timelines for in-person delivered therapy. These findings further support the need for a targeted initiative to improve the timeliness of reperfusion in acute ischemic stroke.