EMS Prenotification to Teleneurologists and Continuous Evaluation: The Impact on Telestroke Metrics

Early initiation of intravenous thrombolytics for treatment of acute stroke leads to improved functional outcomes. Published guidelines aim to reduce door-to-needle (DTN) times in both prehospital and hospital settings without specific consideration of telestroke. Over the last decade, telestroke has become increasingly more common to provide emergency stroke care worldwide but published guidelines on specific practices have yet to be established. The implementation of EMS prearrival notifications, neurologic evaluation and thrombolytic administration in the CT imaging suite (CIS) are utilized as best practices by some programs.

We utilized the Telecare by TeleSpecialists^TM database to investigate the impact of these practices on DTN times and thrombolytic treatment rates. Hospitals participating in all recommended Best Practices were considered the investigative group and those hospitals participating in all Best Practices except the variable of interest were considered the control group. Shapiro-Wilk, Mann-Whitney U, and Pearson's chi-squared tests were used when appropriate.

Pre-notification was associated with an 8-min reduction in DTN times (p = 0.0026) and 3.7% increase in thrombolytic treatment rates (p = 0.0016). Evaluation by the neurologist in the CIS was associated with a reduction in DTN times (6-min reduction, p = 0.0192) and increase in thrombolytic administration rates (1.46% increase, p = 0.0361). Implementing administration of IV thrombolytic in the CIS was associated with similar benefits (3-min reduced DTN times, p = 0.0176; 2.87% increase in thrombolytic treatment rate, p < 0.0001).

Overall, these best practices reduced DTN times and improved treatment rates supporting their integration into telestroke practices globally.