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When Telestroke Programs Work, Hospital Size Really Does Not Matter
Krishna Nalleballe1, Aliza Brown1, Rohan Sharma1
1Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States.
Journal of Neurosciences in Rural Practice
|August 6, 2020
Summary
Telestroke networks ensure timely tissue plasminogen activator (tPA) delivery in rural areas. Hospital size does not significantly impact door-to-needle times, demonstrating the effectiveness of protocol-driven care.
Area of Science:
- Neurology
- Telemedicine
- Health Services Research
Background:
- Significant disparities persist in stroke care between rural and urban populations.
- Rural communities often face higher stroke-related mortality rates.
- Telestroke networks aim to bridge these gaps by extending specialized care.
Purpose of the Study:
- To analyze the efficiency of tissue plasminogen activator (tPA) delivery in spoke sites within a telestroke network.
- To assess the impact of telecare on reducing stroke care disparities.
- To compare critical time targets between different-sized spoke hospitals.
Main Methods:
- Analysis of critical time targets: door-to-needle (DTN), door-to-CT (D2CT), and consult times.
- Comparison of these metrics between larger (>200 beds) and smaller spoke hospitals.
- Inclusion of 825 stroke consults receiving intravenous tPA across 52 spoke sites.
Main Results:
- Smaller hospitals showed significantly lower door-to-CT times in certain bed size categories (0-25, 51-100 beds).
- Smaller hospitals demonstrated significantly lower total consult times in specific bed size groups (26-50, 151-200 beds).
- No significant difference in overall door-to-needle (DTN) times was observed between smaller and larger hospitals.
Conclusions:
- Telestroke networks effectively ensure timely tPA administration, irrespective of hospital bed size.
- Protocol-driven telestroke systems with regular mock codes are crucial for equitable stroke care.
- Telemedicine facilitates timely intervention, mitigating disparities in rural stroke treatment.
