Telestroke consultant use in acute stroke care: Evidence for best practices from the IMPROVE stroke care program

Abstract

Background

Evolving stroke care demands careful screening of stroke patients to ensure the right care is administered to the right patients in a timely manner. Telestroke has been increasingly utilized to improve access to stroke specialists to make these assessments. Here we explore the care processes at these telestroke site to determine if an optimal care process can be determined.

Methods

This is a post-hoc analysis of data collected as part a larger quality improvement program, the IMPROVE stroke care program. We rank ordered and normalized the DTN times from encounters that used telestroke services to range between 0 and 1. We used linear mixed models to assess the acute stroke care process steps most associated with improvement in thrombolytic administration times.

Results

The dataset consisted of 21,456 acute stroke code assessments, of which 8356 (80.6%) were conducted via telestroke (TS) services. Of these TS events, 7088 (84.8%) were conducted at sites that used TS for >85% of all events. Compared to private vehicle, EMS arrival is associated with 4% improvement in DTN ranks, though when paired with prehospital notification, DTN ranks significantly improve by 25%. Key process steps associated with shorter DTN times included calling a code stroke quickly upon arrival and notifying the telestroke consultant prior to obtaining the initial CT scan.

Discussion

Working with local EMS to provide prehospital notification along with rapid code stroke activation and consultant notification prior to CT were identified as best practices for providing timely acute stroke care using telestroke providers.