2026 American Academy of Neurology Abstract Website

Objective:

Compare quality stroke metrics pre-telestroke and post-telestroke implementation in three rural Indiana hospitals. Quality metrics included in this study were frequency of stroke activations, thrombolytic administrations, thrombectomy transfers and door-in-door-out (DIDO) times.

Background:

Telestroke connects a stroke expert to a patient regardless of the patient's emergency room location. The American Heart Association recommends hospital systems should adopt telestroke when onsite experts are not available. Telestroke was recently piloted in three rural hospitals in South Central Indiana.

Design/Methods:

Data was abstracted from August 24^th, 2024, to August 27^th, 2025, and compared to data abstracted from January 2021 to December 2021 at the same three rural sites.

Results:

There was insufficient data collected at rural hospitals prior to telestroke implementation. In 2021; there was an estimated 108 stroke activations, 6 thrombolytic administrations, 14 patients transferred for thrombectomy. DIDO time was not tracked prior to telestroke.

After implementation of telestroke, there were 163 activations, 12 thrombolytic administrations (median door to needle (DTN) time was 80 minutes), and 7 patients transferred for thrombectomy. Median DIDO time was 129 minutes.

The telestroke year, when divided into a first half and second half, demonstrated a trend toward improved DIDO time. Despite in paired t-test DIDO time was not considered significant (p value of 0.08) there was a trend toward improved DIDO with average time in first half of the year being 276 minutes which improved to 119 minutes in the second half of the year.

Conclusions:

Rural hospitals without a formal stroke care system like telestroke may collect insufficient data, limiting the ability of rural hospitals to improve stroke care. After implementation of telestroke, stroke activations increased, thrombolytic rates doubled, and DIDO times trended toward improvement. These metrics reflect improved care for stroke patients.