Abstract WP347: Telestroke Practice With Integrated Quality Improvement Strategy Increases Use of IV tPA in Rural Minnesota.
Background: In Minnesota, stroke is the cause of 2000 deaths, 12,000 hospitalizations with 1 in 3 presenting first to a rural hospital where resources for stroke care are limited. Nationally the percent of all acute ischemic stroke (AIS) patients presenting to acute care hospitals receiving IV tPA remains low with long times to treatment (4.3% and mean DTD time 79 min - GWTG data 2003-2009). This review supports the hypothesis that a stroke system utilizing telestroke with an integrated approach to the team process and quality review will increase the percentage of AIS patients treated and foster short door-to-drug times.
Methods: The HealthEast Telestroke Network began in 2006, currently there are five hospitals within the system. During the implementation, team meetings occur with spoke hospital staff to collaboratively develop the stroke code process which includes a door to drug goal of 30 minutes. Components of this process include use of aggressive triage plan for ambulatory arrivals, partnering with EMS for pre-alerts, specific team member assignments and time goals, early stroke neurology involvement and leadership of the code. This integrated team approach continues into the quarterly quality review with cooperative hub and spoke meetings to address barriers and effect continuous improvement of the process.
Results: Currently, our rate of all ischemic stroke discharges treated across our telestroke network hospitals is 24%. Comparisons between each of the five network hospital’s rates of all ischemic stroke treated is 17% to 34%. Mean door to drug time across the network is 58 minutes, with a range across sites of 46 to 67 minutes and sixty percent of patients receiving IV tPA within 60 minutes or less.
Conclusion: Use of telestroke combined with an integrated approach to the team process and quality review resulted in a sustained high percentage of AIS patients treated with reperfusion therapies with door- to- drug times comparing favorably to nationally reported data.
- © 2012 by American Heart Association, Inc.