Abstract WP427: Implementing an Algorithm Emphasizing Telestroke for Patients With an Acute Cerebrovascular Event in a Rural Setting

Abstract

Background and Purpose: A stroke may occur without warning and deficits can range from mild deficits to death. Improved outcomes are associated with decreased time to revascularization of cerebral tissue. The time sensitive nature of stroke care contributes to the challenges associated with caring for individuals suffering from stroke who live far from a stroke center. The American Stroke Association (ASA) guidelines include a recommendation for the implementation of telestroke. The technology is preferred over telephone consults and is an effective method to determine eligibility of fibrinolytic therapy. Methods: The project was implemented in a stroke ready facility in a rural area and supported by an urban care center that is recognized as a comprehensive stroke center. Stroke education was provided to the rural site and an algorithm utilizing the telestroke technology was implemented. Times from door to CT (computed topography) scan, door to fibrinolytic therapy, and door to transfer time were tracked for 90 days to compare average times to baseline data using a one-tail t-test. Statistical significant was determined with a p-value <0.05. Results: There were 27 patients that presented during the collection period, with a baseline comparison of 39 patients over an 11-month period. Overall, each category had a decrease in time, with significant differences noted in door to CT and door to transfer time. The average door to CT time with telestroke decreased on average by 14.1 minutes from baseline data to a new average of 8.6 minutes. Door to transfer time with telestroke decreased by 42.2 minutes from baseline to a new average of 121.4 minutes. Additionally, during the collection period, fibrinolytic therapy initiation doubled, resulting in 48% receiving therapy. Due to the faster times, 35% of patients were able to receive a thrombectomy at the tertiary site. Conclusions: In conclusion, this study demonstrates promising results for the continuation of telestroke use in rural treatment sites for acute cerebrovascular events to decrease time to interventions for optimal outcomes.