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Expansion of Telestroke Coverage in Community Hospitals: Unifying Stroke Care and Reducing Transfer Rate

Ann Neurol. 2023 Dec 1. doi: 10.1002/ana.26839. Online ahead of print.


BACKGROUND: Telestroke (TS) service has been shown to improve stroke diagnosis timing and accuracy, facilitate treatment decisions, and decrease inter-facility transfers. Expanding TS service to inpatient units at the community hospital provides an opportunity to follow up on stroke patients and optimize medical management. This study examines the outcome of expanding TS coverage from acute ER triage to incorporate inpatient consultation.

METHODS: We studied the effect of expanding TS to inpatient consultation service at 19 regional hospitals affiliated with Promedica Stroke Network. We analyzed data pre- and post-TS expansion. We reviewed changes in TS utilization, admission rate, thrombolytic therapy, patient transfer rate, and diagnosis accuracy.

RESULTS: Between Jan-2018 and June-2022, a total of 9,756 patients were evaluated in our stroke network (4,705 in pre and 5,051 in the post-TS expansion). In the post-TS expansion period, stroke patients’ admission at the spoke hospital increased from 18/month to 40/month and for TIA from 11/month to 16/month. TS cart use increased from 12% to 35.2%. Patient transfers to hub hospital decreased by 31%. TS service expansion did not affect IV thrombolytic therapy rate or door-to-needle time. There was no difference in length of stay or readmission rate, and the patients at the spoke hospitals had a higher rate of home discharge 57.38% compared to 52.58% at hub hospital.

INTERPRETATION: Telestroke service expansion to inpatient units helped decrease transfers and retain patients in their communities, increased stroke and TIA diagnosis accuracy, and did not compromise patients’ hospitalization or outcome. This article is protected by copyright. All rights reserved.

PMID:38038962 | DOI:10.1002/ana.26839

By Nevin Manimala

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