Impact of the Veterans Affairs National Telestroke Program's Subacute Telestroke Service on Interhospital Transfers

Background and Purpose: Telestroke improves access to acute ischemic stroke (AIS) expertise, aids in decision-making, and reduces interhospital transfers. Few studies have examined subacute inpatient telestroke services, which focus on inpatient stroke workup and management. Methods: In this retrospective cohort study of patients with emergency department (ED) diagnosis of AIS from 10/2021-6/2024, we sought to determine the impact of a novel subacute telestroke program on ED transfer rates at participating hospitals. For intervention sites (that implemented the subacute teleconsult program), the period prior to subacute consult "go-live" date was considered the pre-implementation period. Control sites (without the subacute program) were considered preimplementation prior to 5/22/2023 (when approximately half of intervention sites had initiated the subacute program). Logistic regression with generalized estimating equations evaluated the association between implementation time-period and odds of ED transfer in intervention and control sites, adjusting for age, NIHSS, sex, race, and an intervention by time-period interaction term. Results: 1266 patients met eligibility criteria (N = 544 patients from 11 control sites and N = 722 patients from 11 intervention sites). The ED transfer rate was lower within intervention sites post-implementation (pre: 25.7% to post: 22.5%) and higher in control sites (pre: 25.9% to post: 27.1%). These comparisons were statistically nonsignificant in the multivariable analysis. Conclusions: There was a reduction in interhospital transfers after implementation of a subacute telestroke consultation service, but results were nonsignificant in adjusted models. Future analyses should evaluate whether receipt of a subacute telestroke encounter at the patient-level is associated with reduced interhospital transfer for stroke.