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Variability and Delay in Telestroke Physician Alert among Spokes in a Telestroke Network: A Need for Metric Benchmarks.
J Stroke Cerebrovasc Dis 2019; :104332JS

Abstract

INTRODUCTION

Telestroke has increased access to acute management of ischemic stroke in areas that lack stroke care expertise, yet delays persist in evaluation and treatment. We describe variation in time to alert a telestroke physician of suspected acute ischemic stroke patients potentially eligible for acute stroke therapies among community hospitals in our telestroke network, and explore demographic and spoke-related characteristics associated with delays.

METHODS

From our telestroke registry, we identified suspected acute ischemic stroke patients who arrived within 6 hours of symptom onset and underwent video consultation at 1 of 17 community hospitals in our hub-and-spoke network. We compared time between patient arrival to telestroke alert (door-to-page-time) and to tissue plasminogen activator (tPA) administration for eligible patients (door-to-needle-time). We identified factors associated with prolonged metrics.

RESULTS

Of 1020 cases between 9/2015 and 3/2017, 47% received tPA. Sixty percent had door-to-page-time more than 15 minutes (median 19.5; IQR, 11-34). Door-to-page-time more than 15 minutes was associated with an 8-fold increase in likelihood of door-to-needle-time more than 60 minutes. Patients with severe stroke experienced faster door-to-page-times. Hospitals with more beds had prolonged door-to-page-time. Full time in-house neurology presence, even when not covering emergent consultations, was associated with faster door-to-page-time over telestroke. Seventy-one percent of patients underwent CT brain prior to the telestroke physician alert; this scenario delayed door-to-page and door-to-needle times.

CONCLUSIONS

Door-to-page-time varied considerably among spokes. Awaiting CT scan prior to alerting the telestroke consultant of a stroke code delayed metrics. Telestroke physician alert standards are needed, as are educational initiatives on acute ischemic stroke management and workflow.

Authors+Show Affiliations

Department of Neurology, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas. Electronic address: amanda.l.jagolino@uth.tmc.edu.Department of Neurology, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas.Department of Neurology, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas.Department of Neurology, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas.Department of Neurology, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas.Department of Neurology, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas.Department of Neurology, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas.Department of Neurology, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas.Institute for Stroke and Cerebrovascular Disease, Department of Neurology, Houston, Texas; University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas.Department of Neurology, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31439524

Citation

Jagolino-Cole, Amanda L., et al. "Variability and Delay in Telestroke Physician Alert Among Spokes in a Telestroke Network: a Need for Metric Benchmarks." Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, 2019, p. 104332.
Jagolino-Cole AL, Bozorgui S, Ankrom CM, et al. Variability and Delay in Telestroke Physician Alert among Spokes in a Telestroke Network: A Need for Metric Benchmarks. J Stroke Cerebrovasc Dis. 2019.
Jagolino-Cole, A. L., Bozorgui, S., Ankrom, C. M., Vahidy, F., Bambhroliya, A. B., Randhawa, J., ... Wu, T. C. (2019). Variability and Delay in Telestroke Physician Alert among Spokes in a Telestroke Network: A Need for Metric Benchmarks. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, p. 104332. doi:10.1016/j.jstrokecerebrovasdis.2019.104332.
Jagolino-Cole AL, et al. Variability and Delay in Telestroke Physician Alert Among Spokes in a Telestroke Network: a Need for Metric Benchmarks. J Stroke Cerebrovasc Dis. 2019 Aug 19;104332. PubMed PMID: 31439524.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variability and Delay in Telestroke Physician Alert among Spokes in a Telestroke Network: A Need for Metric Benchmarks. AU - Jagolino-Cole,Amanda L, AU - Bozorgui,Shima, AU - Ankrom,Christy M, AU - Vahidy,Farhaan, AU - Bambhroliya,Arvind B, AU - Randhawa,Jaskaren, AU - Trevino,Alyssa D, AU - Cossey,T C, AU - Savitz,Sean I, AU - Wu,Tzu-Ching, Y1 - 2019/08/19/ PY - 2019/05/07/received PY - 2019/06/13/revised PY - 2019/07/27/accepted PY - 2019/8/24/entrez KW - Telemedicine KW - acute stroke care KW - healthcare delivery systems KW - ischemic stroke KW - metrics KW - telestroke SP - 104332 EP - 104332 JF - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JO - J Stroke Cerebrovasc Dis N2 - INTRODUCTION: Telestroke has increased access to acute management of ischemic stroke in areas that lack stroke care expertise, yet delays persist in evaluation and treatment. We describe variation in time to alert a telestroke physician of suspected acute ischemic stroke patients potentially eligible for acute stroke therapies among community hospitals in our telestroke network, and explore demographic and spoke-related characteristics associated with delays. METHODS: From our telestroke registry, we identified suspected acute ischemic stroke patients who arrived within 6 hours of symptom onset and underwent video consultation at 1 of 17 community hospitals in our hub-and-spoke network. We compared time between patient arrival to telestroke alert (door-to-page-time) and to tissue plasminogen activator (tPA) administration for eligible patients (door-to-needle-time). We identified factors associated with prolonged metrics. RESULTS: Of 1020 cases between 9/2015 and 3/2017, 47% received tPA. Sixty percent had door-to-page-time more than 15 minutes (median 19.5; IQR, 11-34). Door-to-page-time more than 15 minutes was associated with an 8-fold increase in likelihood of door-to-needle-time more than 60 minutes. Patients with severe stroke experienced faster door-to-page-times. Hospitals with more beds had prolonged door-to-page-time. Full time in-house neurology presence, even when not covering emergent consultations, was associated with faster door-to-page-time over telestroke. Seventy-one percent of patients underwent CT brain prior to the telestroke physician alert; this scenario delayed door-to-page and door-to-needle times. CONCLUSIONS: Door-to-page-time varied considerably among spokes. Awaiting CT scan prior to alerting the telestroke consultant of a stroke code delayed metrics. Telestroke physician alert standards are needed, as are educational initiatives on acute ischemic stroke management and workflow. SN - 1532-8511 UR - https://www.unboundmedicine.com/medline/citation/31439524/Variability_and_Delay_in_Telestroke_Physician_Alert_among_Spokes_in_a_Telestroke_Network:_A_Need_for_Metric_Benchmarks L2 - https://linkinghub.elsevier.com/retrieve/pii/S1052-3057(19)30385-4 DB - PRIME DP - Unbound Medicine ER -