Implementing Telestroke in the Inpatient Setting: A Qualitative Analysis of Barriers and Facilitators
Solmaz Ramezani Hashtjin1, Samuel Boes1, Christopher Streib1, Maya Peters2, Michael Usher2, Joseph Koopmeiners3, Timothy Beebe4, Genevieve Melton-Meaux5, Deborah Pestka2
1Department of Neurology, 2Center for Learning Health System Sciences, 3Division of Biostatistics, Center for Learning Health System Sciences, 4Division of Health Policy Management, Center for Learning Health System Sciences, 5Department of Surgery, Center for Learning Health System Sciences, Institute for Health Informatics, University of Minnesota
Objective:
To identify facilitators and barriers to the implementation of a multi-site inpatient telestroke program.
Background:
Inpatient telestroke programs have emerged as a solution to providing timely stroke care in underserved areas, but the factors facilitating or inhibiting their implementation and effectiveness remain underexplored.
Design/Methods:
A hub-and-spoke inpatient telestroke program was established wherein inpatient stroke care for patients at five community sites (“spokes”) was managed virtually by providers at two distant comprehensive stroke centers (“hubs”). This inpatient telestroke program was evaluated through semi-structured qualitative interviews with sixteen inpatient providers (physicians and nurse practitioners) at spoke sites. The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided data analysis, focusing on four aspects of implementation: the innovation, recipients, context, and facilitation. Responses were coded inductively in NVivo using thematic analysis.
Results:
Fifteen themes were identified in the data and mapped to the i-PARIHS framework. Themes related to innovation (the telestroke program) included easy access to stroke specialists, the benefits of limiting patient transfers, concerns about duplicating tests, and challenges completing inpatient telestroke visits and documentation to facilitate timely discharge. Themes pertaining to recipients (care team members and patients) were communication gaps between teams, concern about the supervision of inpatient telestroke advanced practice providers, and challenges with nurse empowerment. With regards to the context (hospital and system factors), providers highlighted familiarity with telehealth technologies as a facilitator to implementing inpatient telestroke and described resource limitations in smaller facilities. Facilitation (program implementation) was recognized as crucial for education, standardization, and buy-in.
Conclusions:
Understanding barriers and facilitators to implementation of our inpatient telestroke program can inform necessary adaptations that increase the likelihood of success and sustainability. Our findings may be broadly transferrable to the implementation of inpatient telestroke, teleneurology, and other subspecialty telemedicine programs.