Abstract WP304: Telemedicine Utilization Practices and Barriers to Use for Stroke Care in North Dakota Critical Access Hospitals

Abstract

Introduction: Telemedicine (TM) is a promising solution for providing timely and efficient care for patients experiencing a stroke in rural and underserved areas . Although TM services are available in many Critical Access Hospitals (CAHs), wide adoption has been limited by a multitude of barriers. Purpose: To describe current utilization practices and identify barriers to utilization of TM services in assessment and treatment of stroke patients in North Dakota CAHs. Methods: Directors of Nursing (DONs) at Acute Stroke Ready CAHs in North Dakota were recruited to participate in data collection efforts using a mixed methods approach including a survey and in-person focus groups. An online survey was disseminated via email to DONs (response rate=74%) and a semi-structured interview guide was used to conduct three focus groups (n=16). Sessions were digitally recorded and field notes with abridged transcripts were analyzed for recurrent themes using content analysis. Results: Most participants (91.3%) indicated CAH staff have access to TM services that include consultation with emergency medicine physicians, but only 17.4% indicated their services include consultation with a neurologist. Despite wide availability, participants reported staff forget to use existing TM services or are unaware of specific services available. Most frequently used TM services include assistance with patient documentation, medication dosage checks, and assistance with patient transport. Least frequently used TM services include ePharmacist consults and physician assistance with stroke assessments. Identified barriers to utilization of TM services include high confidence level of attending providers in performing independent assessments, staff concerns that decisions will be questioned, and preference of attending providers to directly contact physicians at accepting Primary Stroke Centers. Conclusions: While general TM services are widely available in North Dakota CAHs, services are underutilized. Access to specialized neurology services via TM is also limited. Targeted efforts to enhance understanding and utilization of existing TM services, particularly for stroke patients, will be beneficial to improving stroke systems of care in North Dakota.