Impact of discontinuation of telestroke: the Nelson experience

In 2016, five Central New Zealand hospitals piloted a successful telestroke service that has since transitioned to 'business as usual'. Nelson Hospital elected to opt out of the service after completion of the pilot. This paper reports the impact of telestroke service discontinuation on service provision within a regional and national context.

This is a sequential comparison of three time periods: six months pre-telestroke, six months during telestroke and six months post-telestroke pilot. Main outcomes were thrombolysis rate and door-to-needle time comparing the period with telestroke to the periods without.

Over the 18-month period the thromboloysis rate was 8.5% (6/71) over the six months pre, 23.0% (14/61) over the six months during and 7.9% (5/63) over the six months post the use of telestroke support. The odds ratio (95% CI) of being thrombolysed with versus without telestroke support was 3.33 (1.41-7.86); p=0.006). Patients receiving thrombolysis within 60 minutes of arrival were 50% before, 64% during and 20% after telestroke (OR (95%CI) 3.15 (0.61-16.3); p=0.16). Other hospitals that continued with telestroke maintained their rates and door-to-needle times between pilot and post-pilot periods.

These findings indicate that the transient implementation of telestroke was insufficient to upskill provincial hospital generalist clinicians to sustain high thrombolysis rates.