Nick Lawrence

Background : Telestroke is well-established; however, there is sparse large-scale data on effectiveness of telestroke to improve acute treatment within rural systems-of-care. Specialist-On-Call© is the largest national provider of tele-emergency consults (23,000/yr). We evaluated the effectiveness of telestroke to improve access/timeliness of treatment for rural patients within the UVA-Telestroke program and the SOC tele-network. [HRSA#G01RH27869] Methods: PhaseI: De-identified patient data were pooled from 46 hospitals [2012-15,n=4,462]. 73[percnt] encounters were acute ischemic strokes; 19[percnt] were tPA treated. Demographics, NIHSS, [percnt] treated with tPA Results: 53[percnt] of AIS patients were >65yo. NIHSS = 0-8 in 79[percnt], 9-15 in 11[percnt], and >16 points in 10[percnt]. For tPA patients, NIHSS was 0-8 in 53[percnt], 9-15 in 23[percnt], >16 in 25[percnt]. 73[percnt] of tPA patients were treated <180min from LSN. 17[percnt] of AIS patients received tPA within 4.5hrs of LSN. The median Door-To-Needle time was 83min; 22[percnt] received tPA ≤ 60min DTN. AIS patient arrival to call initiated was 44min. Median call time to videoconsultation was 20min for AIS/tPA patients. PhaseII (on-going): Stroke ED educational STAT-PAKs were successfully piloted to rural EDs; on line telepresenter training has been launched. Conclusions : This is the largest outcomes study to date of acute telestroke encounters in rural US hospitals. The number of AIS consults treated with tPA was high indicating increased access to acute tele-neurological expertise. Teleconsultation physician response time was rapid, while patient arrival time to consult call was much longer. More work is needed to ensure better adherence to DTN guidelines. In PhaseII, we are determining the impact of an innovative telestroke education program on timeliness/outcome of treatment. Disclosure: Dr. Solenski has nothing to disclose. Dr. Southerland has received personal compensation in an editorial capacity for Neurology podcast. Dr. Shephard has nothing to disclose. Dr. Hillman has nothing to disclose. Dr. McMurry has nothing to disclose. Mr. Lawrence has received personal compensation for activities with a commercial entity. Dr. Schweickert has nothing to disclose. Dr. Wibberly has nothing to disclose.

Background: Telestroke (TS) is well established, yet there is a lack of large-scale, outcomes data on TS effectiveness to improve acute treatment in rural systems of care. Specialist On Call © is the largest national provider of tele-emergency consults, with &gt; 23,000 consults/yr.; 61% are acute stroke consults. Funded by a HRSA grant, we evaluated effectiveness of TS programs to improve access and timeliness of tPA treatment n the UVA Telestroke and SOC tele network of rural hospitals. Methods: Phase I: Rural hospitals were defined by OMB standards. Aggregated SOC data were pooled from 46 hospitals 2012-15; (4,462 consults). 73% of patient encounters (3,247) were t ischemic strokes (AIS); 19% (578) were tPA treated. Data were analyzed for demographics, NIHSS score, % patients treated tPA &lt; 60 min, and % treated within 3 hrs. of LSN. Phase II: An online CEU/CME telestroke-presenter training program was designed to teach emergency staff clinical/technical skills to facilitate TS encounters. www.startelehealth.org/. Results: 53% of AIS patients were ≥ 65 yo; 47% ≤ 65 yo. In AIS patients, NIHSS was 0-8 in 79%, 9-15 in 11%, and 16-40 in 9.6%. For tPA treated patients, NIHSS was 0-8 in 53%, 9-15 in 23 % and 16-40 in 25%. A total of 73.2% of tPA patients were treated 180 min from LSN. 16.8% of AIS patients received tPA within 4.5 hrs of LSN. DTN median time was 83 min. 22% received tPA ≤ 60 min DTN. Patient arrival to SOC call initiated was 44 min (median). Call to video consult was 20min for both AIS and tPA patients. Phase II: Stroke protocol packets are being piloted in rural TS hospitals, and online telepresenter training has been launched (in progress). Conclusions: This is the largest outcomes study of acute TS encounters in rural US hospitals. Treatment in AIS with tPA was high (19%) indicating increased access to acute tele-neurological expertise. Teleconsultation physician response time was rapid, while patient arrival to SOC call time was much longer. Work is needed to ensure better adherence to DTN &lt; 60min in rural hospitals consistent with AHA-ASA GL. In Phase II, we will determine impact of TS education programs to improve timeliness of treatment (stroke-specific tele-presenter training &amp; triage protocols) in comparison to control.