Abstract
Background: Admission outside normal business hours has been associated with prolonged door-to-treatment times and poorer patient outcomes, the so called “weekend effect. ” This is the first examination of the weekend effect in a telestroke service that uses multi-modal computed tomography.Aims: To examine differences in workflow and triage between in-hours and out-of-hours calls to a telestroke service.Methods: All patients assessed using the Northern New South Wales (N-NSW) telestroke service from April 2013 to January 2019 were eligible for inclusion (674 in total; 539 with complete data). The primary outcomes measured were differences between in-hours and out-of-hours in door-to-call-to-decision-to-needle times, differences in the proportion of patients confirmed to have strokes or of patients selected for reperfusion therapies or patients with a modified Rankin Score (mRS ≤ 2) at 90 days.Results: There were no significant differences between in-hours and out-of-hours in any of the measured times, nor in the proportions of patients confirmed to have strokes (67.6 and 69.6%, respectively, p = 0.93); selected for reperfusion therapies (22.7 and 22.6%, respectively, p = 0.56); or independent at 3 months (34.8 and 33.6%, respectively, p = 0.770). There were significant differences in times between individual hospitals, and patient presentation more than 4.5 h after symptom onset was associated with slower times (21 minute delay in door-to-call, p = 0.002 and 22 min delay in door-to-image, p = 0.001).Conclusions: The weekend effect is not evident in the Northern NSW telestroke network experience, though this study did identify some opportunities for improvement in the delivery of acute stroke therapies.
Highlights
The John Hunter and Gosford Hospitals provide telestroke services to five rural hospitals within the Hunter New England Local Health District and the adjacent Mid-North Coast Local Health District (New South Wales, Australia), together representing ∼1.1 million inhabitants in an area over 143,000 km2
The telestroke network aims to identify patient candidates for acute reperfusion therapies; thrombolysis, which is delivered at the spoke hospital and mechanical thrombectomy (MT) which requires transfer to John Hunter Hospital [1]
Studies in the USA [8] and Germany [9] have indicated that telestroke services are less prone to the weekend effect, but this has not been examined telestroke services that offer mechanical thrombectomy (MT) nor any telestroke service that relies on multi-modal computed tomography imaging for treatment decisions
Summary
The John Hunter and Gosford Hospitals provide telestroke services to five rural hospitals within the Hunter New England Local Health District and the adjacent Mid-North Coast Local Health District (New South Wales, Australia), together representing ∼1.1 million inhabitants in an area over 143,000 km. The telestroke network aims to identify patient candidates for acute reperfusion therapies; thrombolysis, which is delivered at the spoke hospital and mechanical thrombectomy (MT) which requires transfer to John Hunter Hospital [1]. Both therapies are time-sensitive and require developed acute stroke pathways to minimize doorto-thrombolysis (needle) (DTN) and door to groin puncture times [2,3,4]. In secondary analyses we examined differences between individual hospitals, differences between groups of hospitals sorted by experience in the telestroke network and the effects of factors such as stroke severity and time from symptom onset to presentation on hospital timings The latter was examined both before and after the criteria for reperfusion therapy was extended to 24-h. Admission outside normal business hours has been associated with prolonged door-to-treatment times and poorer patient outcomes, the so called “weekend effect. ” This is the first examination of the weekend effect in a telestroke service that uses multi-modal computed tomography
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