Abstract 3647: Institution of a Telemedicine for Acute Stroke Protocol in a Major Metropolitan Setting to Decrease iv-tPA Administration Times
Introduction: Telemedicine for Acute Stroke Evaluation and Treatment has been widely used for providing expert stroke neurology advice for patients presenting to rural hospitals. Iv-TPA administration rates in these experiences are high (20-25%). However, national iv-tPA administration rates still are below this level. In addition, less than 30% of patients are receiving iv-tPA in less than 60 minutes. We describe a novel telemedicine network that augments existing on-call neurological support to decrease door to needle times for iv-tPA administration.
Methods: Data from 6 metropolitan hospitals in the Denver area were collected to assess rapidity of iv-tPA administration for Acute Ischemic Stroke. All hospitals had existing acute stroke protocols, on-call board certified neurologists, board certified Emergency Room Physicians (EDP) available on a 24/7 basis. Stroke Program leaders including Emergency Room Physicians, Neurologists, and administrators from these hospitals were invited to participate in an initiative to decrease door to needle times. Through this committee, consensus was reached that the arrival of a neurologist be less than 15 minutes from arrival of the patient to the Emergency Room. At times and places where this could not be achieved by physical presence, telemedicine technology was employed. This Telemedicine Intiative (TI) was instituted on May 1st, 2011. Time data regarding patient arrival, time to CT scan, time in CT scan, arrival of neurologist, first Emergency Room physician evaluation, tPA administration will be tracked.
Results: Prior to institution of the Telemedicine Initiative, average door to needle times for the six hospital network was 86 minutes. In the first month of institution of TI, average door to needle times decreased to 67 minutes across the network. 102 telemedicine consultations have been performed to date. All telemedicine consultations were instituted within 10 minutes of arrival of the patients to the emergency room.
Conclusions: Employing Telemedicine in a metropolitan hospital setting with exisiting neurological coverage, acute stroke protocols and board certified ED Physicians may decrease the time needed to administer iv-TPA in acute ischemic stroke patients.
- © 2012 by American Heart Association, Inc.