Abstract WP63: Direct Physician Call to Spoke Reduces Door to Needle Time in a Telestroke Network

Abstract

Background: Door-to-needle time (DTN) and strategies to reduce DTN are well published, but less is known about specific processes that may contribute to DTN in sites using telestroke. We aimed to reduce potential delays in connecting the telestroke physician with the spoke by eliminating the initial call by telestroke physicians to the call center. Methods: A retrospective analysis examined telestroke patients treated with IV thrombolysis from 06/01/2018 to 03/15/2023 in a 20 spoke network. Telestroke physicians began calling the spoke back directly (instead of calling transfer center to be connected) in July 2022. We compared data and outcomes in the two groups; Prior to Direct Phone (PDP) and After Direct Phone (ADP). Primary outcome analyzed DTN before and after direct connection. Secondary outcome was telestroke page to video times. Primary and secondary outcomes were analyzed using quantile regressions specifying the median, adjusted for confounding variables determined in preliminary analyses. A subgroup analysis was completed in patients transferred for endovascular thrombectomy (EVT) after IVT, to evaluate Door in Door out time (DIDO), using a median regression adjusted for potential confounding variables. Results: There were 580 patients in this study; 469 patients in the PDP group and 111 patients in the ADP group. Patients had a mean age and SD of 69.13 ±15.03 years and a median NIHSS (interquartile range) of 6 (4, 12). After adjusting for potential confounding variables, DTN in the ADP group was 9.22 minutes quicker than in the PDP group, [95% Confidence (CI), 2.07 - 16.36], p = 0.01. Adjusted telestroke page to video times were 2.60 minutes quicker in the ADP compared to the PDP group, [95%CI, 0.01 - 5.20], p = 0.05. There were 137 patients (121 in PDP; 24 in ADP) in the subgroup analysis. There were similar DIDO times in both groups; 1.06 minutes faster in the ADP group, but not statistically significant [95%CI, -14.56, 16.68], p = 0.89. Conclusion: Eliminating one step in the telestroke process by connecting directly to the telestroke site resulted in faster treatment times. Removing the call center from the initial phone call did not delay DIDO times but the downstream effect from removing the step was likely minimized in patients transferred for EVT.