When Telestroke Programs Work, Hospital Size Really Does Not Matter

• Main Authors: Krishna Nalleballe, Aliza Brown, Rohan Sharma, Sen Sheng, Poornachand Veerapaneni, Kelly-Ann Patrice, Vishank Shah, Sanjeeva Onteddu, William Culp, Curtis Lowery, Tina Benton, Renee Joiner, Nidhi Kapoor
• Format: Article
• Language: English
• Published: Thieme Medical and Scientific Publishers Pvt. Ltd. 2020-06-01
• Series: Journal of Neurosciences in Rural Practice
• Subjects: acute stroke care; cerebrovascular accident; emergency; telestroke; hospital bed size
• Online Access: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1709362

Background There are still marked disparities in stroke care between rural and urban communities including difference in stroke-related mortality. We analyzed the efficiency of tissue plasminogen activator (tPA) delivery in the spoke sites in our telestroke network to assess impact of telecare in bridging these disparities. Methods We analyzed critical time targets in our telestroke network. These included door-to-needle (DTN) time, door-to-CT (D2CT) time, door-to-call center, door-to-neurocall, and total consult time. We compared these time targets between the larger and smaller spoke hospitals. Results Across all the 52 spokes sites, a total of 825 stroke consults received intravenous tPA. When compared with larger hospitals (>200 beds), the smaller hospital groups with 0 to 25 and 51 to 100 beds had significantly lower D2CT time (p-value 0.01 and 0.005, respectively) and the ones with 26 to 50 and 151 to 200 beds had significantly lower consult time (p-value 0.009 and 0.001, respectively). There was no significant difference in the overall DTN time when all the smaller hospital groups were compared with larger hospitals. Conclusion In our telestroke network, DTN times were not significantly affected by the hospital bed size. This shows that a protocol-driven telestroke network with frequent mock codes can ensure timely administration of tPA even in rural communities regardless of the hospital size and availability of local neurologists.