Evaluation of the Experience of Spoke Hospitals in an Academic Telestroke Network

Implementation of telestroke has been associated with improved thrombolysis rates and clinical outcomes in remote or neurologically underserved spoke hospitals. Yet, the experience of spoke hospitals using telestroke has not been well described. We sought to characterize spoke hospitals' perceptions of telestroke to understand perceived advantages, challenges, and barriers to use.Within our northeastern US telestroke network, we conducted scripted interviews with representatives (stroke coordinators, nurse managers, and emergency physicians) from each of the 15 spoke hospitals connected to a single academic hub hospital. Interview questions included both open-ended and Likert scale responses. We used descriptive and nonparametric analyses (e.g., logit) to present the results.Of the 15 spoke hospitals interviewed, the majority felt that telestroke enabled them to treat more patients with the tissue plasminogen activator (tPA; 93.3%, n = 14) and to achieve faster door-to-needle times for tPA treatment (80%, n = 12). Higher Likert scores were not correlated with hospitals' consult volume or tPA volume. The most commonly reported barriers to using telestroke were providers who were not familiar or comfortable using the technology (66%, n = 10). Few hospitals had concerns that telestroke led to overtreatment with tPA (13.3%, n = 2) or led to unnecessary transfers (20%, n = 3). None of the hospitals felt that the physician-patient relationship was compromised, nor was there a concern that patients would have a negative perception of the spoke hospital with utilization of services.Within this single hub-spoke telestroke system in the northeast, we found that spoke hospitals perceive the advantages of telestroke to be in enabling improved rates and efficiency of tPA administration. Barriers to use were most often related to technological challenges rather than concerns about patient care or patients' perceptions. Future work should further explore how to better meet the needs of spoke hospitals in caring for stroke patients.