Abstract T P212: One Year Experience Of An Urban Primary Stroke Center With An Integrated Internal Telestroke System
Background: Telestroke systems have offered expert stroke care to underserved communities across the United States. Usually, the telestroke service is provided by external consultants, from other institutions with limited access to patients’ medical charts and prior imaging. Here, we report on our one-year experience of an internal telestroke system at a community Primary Stroke Center. Methodology: Prior to August 2013, assessment of thrombolytics was provided by in-house neurologists through bedside consultation during the day and telephone consultation after hours. However, starting August 2013 acute stroke care is provided by neurologists using a telemedicine device via an integrated internal telestroke program. Given the integrated nature of our hospital system, these physicians have immediate access to medical charts, history, laboratory, and prior as well as current imaging. In order to prove the viability of this program, we compared outcomes between the two acute stroke care processes. We determined thrombolytic utilization rate, door-to-needle time (DNT), rate of stroke mimics, and discharge destination of those patients who received thrombolytics 12 month before and after telestroke implementation. Results: We noted improvement in the percentage of eligible stroke patients receiving thrombolytics (8% vs 18.2%). Our DNT decreased by 23 minutes (mean 93.4 vs 69.7 minutes, P<0.005). Thrombolytics administered to stroke mimics was reduced from 16.7% to 8.6%. Patients discharged to a non-home facility (acute rehabilitation or skilled nursing facilities) decreased from 16.6% to 8.6%. Conclusion: Compared to our previous local acute stroke management, stroke care was not inferior. In fact, as a result of an internal telestroke system implementation, our thrombolytic utilization rate increased, our DNT improved, our stroke mimic rate decreased, and non-home discharge disposition decreased. Although not specifically assessed in our study, we suspect that internal telestroke systems also offer obvious advantages for patient care compared to external systems. Further studies evaluating stroke outcomes in these distinct systems are needed.
Author Disclosures: E. Diep: None. Y. Bronstein: None. M. Danesh: None. Z. Ajani: None. N. Sangha: None. G. Balkian: None. M. Petrovic: None.
- © 2015 by American Heart Association, Inc.