Teleneurology Pre-notification Reduces Time to Thrombolysis in Acute Stroke
Mark McDonald1, Yelena Vidgop1, Oleg Collins2, Lan Gao2, Theresa Sevilis1
1TeleSpecialists, 2College of Medicine, University of Tennessee at Chattanooga
Objective:
To evaluate the impact of teleneurologist pre-notification on acute stroke treatment
Background:
Telestroke is a widely used modality for acute stroke care delivery but there is limited guidance on standard practices including teleneurologist notification timing. While EMS pre-notification of the receiving hospital for potential stroke patients is considered standard of care, teleneurologist pre-notification is variable.
Design/Methods:
Acute telestroke consultations seen in the Emergency Department in 103 facilities and 15 states were extracted from the Telecare by TeleSpecialistsTM database. TeleSpecialists recommends 15 best practices for facilities, including pre-notification of teleneurology when the facility is notified. Facilities that did not utilize the other 14 best practices were excluded. Cases were reviewed for arrival mode, arrival time, teleneurologist notification time, thrombolytic treatment, and door-to-needle (DTN) time. Facilities with and without the pre-notification process in place were compared for DTN times. Cases in which pre-notification actually occurred vs not were compared at facilities with the pre-notification process in place.
Results:
There were 9,290 patients included: 8,647 at pre-notification (PN) facilities and 643 at no pre-notification (NPN) facilities. In the NPN group, 31 patients (4.8%) were treated with thrombolytics compared to 731 (8.5%) in the PN group, p=0.002. The median DTN time for the NPN group was 43 minutes and for the NP group was 35 minutes, p=0.01. Further breaking down the PN group into actual pre-notification vs being at a facility with the process, the actual pre-notification median DTN time was 29 minutes compared to 41.5 minutes for the cases in which pre-notification did not occur, p<0.001.
Conclusions:
Teleneurologist pre-notification significantly reduces DTN times and may allow for more patients to be treated within 30 minutes of arrival, an increasingly utilized target shown to improve outcomes and reduce length of stay. Prospective evaluation of the benefit of implementing teleneurologist pre-notification as standard practice in telestroke systems is warranted.