Abstract W P57: Telemedicine in Urban Primary Stroke Centers Overcomes the “Weekend Effect” in Door-to-Needle Times for Acute Ischemic Stroke
Purpose: To assess whether utilization of telemedicine technology during weeknights and weekends improves door to needle times in Primary Stroke Centers (PSC). Background: There is a well-documented “weekend effect” of slower door-to-needle times for thrombolysis for acute ischemic strokes, compared to weekdays, ostensibly due to the absence of in-person vascular neurologists during evening and weekend hours. Telemedicine provides rapid access to stroke neurologists at rural sites, but a role in urban Primary Stroke Centers has not been defined. A possible reason for this is that current CMS guidelines restrict reimbursement for telemedicine to urban facilities. Method: Providence Stroke neurologists utilized telestroke within two metropolitan PSC “Hub” hospitals for assessment of acute stroke patients during off hours. We analyzed American Stroke Association’s Get with the Guidelines data for all IV-tPA treated ischemic stroke patients that presented at our PSC hubs from January 2010 through March 2014. Of 265 patients treated, 124 were weekday (8am-4pm) consults, and 141 were weekend (4pm Friday through 8am Monday) or evening (4pm-8am) consults. We compared door to needle times for daytime vs. evenings/weekends. Data was analyzed using one-way ANOVA and Pearson’s chi-square between groups for telestroke and non-telestroke cases. Results: We confirmed a significant weekend effect in our hubs, with a mean door to needle time of 54.2 minutes (± 18.4) for weekday and 67.6 minutes (± 28.8) for evenings/weekends (p<.0001). However, using telestroke significantly improved evening/weekend door-to-needle times with a mean of 62.2 (± 23.0) minutes (n=73) compared to 72.6 (± 32.7) minutes (n=68) when telestroke was not used, (p=.031). Conclusion: Our data supports using high-quality telemedicine in urban Primary Stroke Centers to improve stroke care by eliminating the treatment delays caused by the weekend effect. Given this finding, we feel CMS should revisit reimbursement methodologies.
Author Disclosures: L.R. Yanase: None. A. Lesko: None. T. Stuchiner: None. E. Baraban: None.
- © 2015 by American Heart Association, Inc.