Improving Telestroke Performance in Rural Systems of Care - The EQUITe Initiative (P6.084)

Abstract

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.