Stroke Alert: Utilizing Telestroke Technology for Rapid Brain Saving Intervention

Abstract

Session E presented Friday, September 28, 10:00-11:00 am Purpose: The purpose of telestroke technology is to provide the highest quality expert care to patients arriving to the Emergency Department (ED) with acute stroke symptoms. The telestroke “third party consult model” was developed to consult a neurologist from another hospital system to promote the care of the patients in this ED. This process facilitates assessment, intervention and expert care in a facility where neurology services are not readily available. Early identification of stroke patients meeting criteria for intervention, will promote significant reduction in brain damage or death. Design: A quality improvement process, utilizing evidence based practice, to promote the care of patients presenting to the ED with neurological symptoms. Setting: The setting for this project is a community hospital that is affiliated with certified stroke center. The ED evaluates approximately 53,000 patients a year and transfers about 2.6% of patients. Approximately 300 potential stroke patients present to this facility for evaluation and treatment. This hospital does not have 24-hour neurology coverage and transfers most patient with neurology complaints. The facility is a teaching hospital with a residency program. Participants/Subjects: The participants in this process include: all ED patients presenting with neurological deficits arriving with 6 hours of the “last know well”, the ED medical and nursing staff, the neuroscience staff at the local stroke center and the consulting hospital system. Methods: Members of the Neuroscience and Emergency Department teams collaborated to create process and procedures to improve the care of acute stroke patients. The multidisciplinary team evaluated current processes and delays. The goal was to develop a clinical operation and technical process, develop staff competency and proficiency, and to test and utilize the telestroke system. Through these meetings, policy updates were completed, plans for staff education and mock drill were discussed. The updated process would include: early recognition of presenting stroke patients and expert assessment and treatment those who meet specific criteria are eligible for the administration of thrombolytic therapy and/or endovascular intervention. The process was implemented in June, 2017. Telestroke utilizes a video conference technology that connects the ED to a neurologist who can: assess a person who has had a stroke, communicate with the patient, family and onsite ED staff, view the patient’s medical records and results, provide support to the ED physician to determine the most effective stroke therapy, and assist with decision to transfer the stroke patient, when appropriate. Results/Outcomes: From June to November, the telestroke was utilized on 18 patients in this ED. Four of these patients met criteria and were administered tissue plasminogen activator (tPA) intravenously per hospital protocol. The average door medication time was 52.5 minutes with a goal of less than 60 minutes. Prior to telestroke the average door to needle time for January to June was greater than 100 minutes. In conclusion, telestroke technology has drastically improved the outcomes of patients presenting the ED with acute stroke symptoms. Implications: In a facility where neurological coverage in not available 24 hours a day, a telestroke process can be beneficial for rapid brain saving intervention in acute stroke patients.