Objective:

Thrombolytic treatment in the CT-imaging suite (CIS) is a Target Stroke best practice, therefore it is hypothesized that taking the Telecart to CT and initiating treatment in CT will reduce door-to-needle (DTN) times. 

Background:

The benchmarks for acute stroke evaluation and treatment have been adopted per the best practice guidelines provided by the ASA/AHA, but there is limited data in the guidelines regarding Telestroke specific workflow standards.

Design/Methods:

Acute stroke evaluations by TeleSpecialists, LLC neurologists completed July 2021 - December 2021 were extracted from the Telecare by TeleSpecialistsTM database. TeleSpecialists recommends 15 best practices for facilities, including evaluation and administration of thrombolytics in CIS. Facilities that did not utilize the other 13 best practices were excluded. Patients were separated into two groups (Telecart or no Telecart to CIS) based on the institutional stroke protocol. We analyzed age, gender, NIHSS score, and arrival-to-notification time. DTN time (minutes) and thrombolytic treatment rate were compared between groups. 

Results:

A total of 15,118 patients were included with 13,626 (90.1%) accompanied via Telecart to the CIS and 1,492 (9.9%) were not accompanied to the CIS. Those accompanied to the CIS experienced faster door-to-needle times (37.0 [27.6, 50.0]) than those not accompanied to the CIS (43.0 [32.6, 53.5]; p = 0.0192). There was a higher intravenous thrombolytic (IVT) treatment rate for the Telecart to CIS (692 [7.8%]) than the no Telecart to CIS group (228 [4.8%]; p < 0.0001). Treatment in the CIS also resulted in reduced DTN times (36.1 [27.0, 49.5] vs. 39.5 [29.6, 51.7]; p = 0.0176).  

Conclusions:

Telestroke video evaluation in the CIS is associated with a 6-minute reduction in door-to-needle time and of those treated in CT there was a 3-minute reduction in door-to-needle time. Telecart to the CIS and treatment with thrombolytics in the CIS should be a Telestroke Best Practice.