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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
PubMed
Summary
This summary is machine-generated.

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.

Keywords:
acute stroke carecerebrovascular accidentemergencyhospital bed sizetelestroke

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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.