ABSTRACT
BACKGROUND: Like all medical innovations, telestroke must demonstrate successful outcomes to achieve sustained growth and acceptance. Asserting that telemedicine is faster, employs the latest technology, or promotes a better use of limited resources is laudable but insufficient. An analysis of stroke treatment within a telemedicine network in 2013 showed that tissue-type plasminogen activator (tPA) could be safely and reliably administered within a practice-based model of telestroke care. Since then, hospital volume and tPA administration within this network have tripled. We hypothesize that a practice-based model of telestroke can maintain positive outcomes in the face of rapid growth. METHODS: Data on tPA treatment times and outcomes after thrombolysis were gathered for 165 patients treated with alteplase between November 2012 and November 2014. Comparisons were made to a previous published study of 54 patients seen between October 2010 and October 2012 in the same network. Primary outcome measures were average door-to-needle (DTN) time for TPA administration and average call-to-needle (CTN) time. RESULTS: Significant reductions were observed in median DTN (93 versus 75 minutes, P < .01) and median CTN (56 versus 41 minutes, P < .01). Quality outcome measures such as post-tPA symptomatic hemorrhage (2 [4%] versus 9 [5%], P = .23), length of stay (4 versus 4 days, P = .45), mortality (8 [15%] versus 16 [10%]; P = .32), and percentage of stroke patients treated remained stable. CONCLUSIONS: This study shows that a practice-based telemedicine system can produce meaningful improvement in markers of telestroke efficiency in the face of rapid growth of a telestroke network.
Subject(s)
Brain Ischemia/drug therapy , Fibrinolytic Agents/therapeutic use , Stroke/drug therapy , Telemedicine , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Quality Improvement , Time Factors , Time-to-Treatment , Treatment Outcome , Young AdultABSTRACT
Emergency stroke treatment would benefit from the increased use of thrombolysis via academic or practice-based telemedicine systems. However, a comparative analysis of these systems has not been undertaken. Data on stroke severity and outcomes after thrombolysis were gathered on patients treated by a practice-based system and compared to published data from academic systems. Patient demographics and outcome measures were not significantly different for patients treated by practice-based or academic providers with the exceptions of lower age and shorter duration of stay in the practice-based treatment group. This study shows that emergency stroke care provided by academic and practice-based telemedicine systems can achieve similar outcomes.