Abstract 200: Team of Neurohospitalists, Telestroke, and Nurse Stroke Coordinator Increases the Use of Intravenous Alteplase in a Community Hospital
Background and Purpose: The FDA approved IV tPA in 1996 for the treatment of AIS. Its safety and efficacy have been demonstrated in community hospitals (CH) and it is now the standard of care; but intravenous Alteplase (IV tPA) remains underemployed. It is used in fewer than 5% of AIS patients. Short supply of neurologic manpower and concern over adverse effect contribute to this underutilization. Our hypothesis was that a combination of onsite neurohospitalists (NH), telestroke (TS), nurse stroke coordinator (NC), and education of staff and community would increase IV tPA use in a mid-sized CH PSC without compromise of safety or outcome.
Methods: The hospital is a 197 bed nonprofit hospital located 60 miles from Atlanta serving a population of 350,000 in 10 counties. The hospital has been certified as a PSC since August 2004; however, the volume of AIS admissions and use of IV tPA remained low through 2008. The stroke program thus was reorganized in 2009: two full-time NH were hired to provide onsite coverage daily from 8am to 6pm, the REACH™ TS System was installed to provide the remainder of coverage, a NC was hired, and an education plan for staff and community was implemented. Patients treated with IV tPA via TS were admitted to the neuro-ICU by medical hospitalists initially with NH assuming primary care of these patients within hours. AIS admission and IV tPA use data for 2002- 2008 were compared with those for 2009 - 2012. Outcomes, assessed at discharge, 2009 - 2012 were also examined. Favorable outcome was defined as a mRS of 0 or 1.
Results: From 2002-2008, 25 of 933 AIS were treated with IV tPA: 3.6 per year (2.7%). In contrast, from 2009-2012, 105 of 802 AIS received IV tPA: 26.25 per year (13%) with favorable outcome in 47 (45%). Of 64 patients treated by NH, 28 (44%) achieved favorable outcome as did 19 of 41 (46%) TS patients. These outcomes were not statistically different (p=0.92). There were 5 deaths (3 NH, 2 TS), none attributable to tPA. There were no sICH.
Conclusions: A model combining NH, TS, NC, and education in a CH PSC significantly increased the use of IV tPA without compromising safety or effectiveness. Such a model may be an option where resources are limited.
Author Disclosures: H. Smith: None. C. Morris: None. S. Nichols: None. J. Lockamy: None. J.A. Switzer: Consultant/Advisory Board; Modest; REACH Health, Inc.. Research Grant; Significant; Research grants for Genentech on Telestroke Networks. Other; Significant; Georgia Regents Medical Center employs Dr Switzer and the hospital provides contracted telehealth services to hospitals in Georgia and South Carolina for telestroke. D.C. Hess: Other Research Support; Modest; Athersys, Inc., Clinical Investigator. Consultant/Advisory Board; Significant; REACH HEALTH, Inc.. Other; Modest; DSMB Chair, Pfizer.
- © 2014 by American Heart Association, Inc.