Evaluate emergent stroke time metrics at a comprehensive stroke center during after hours stroke codes before and after initiation of telestroke technology.

After hours stroke codes are associated with significant delays in patient evaluation. Key factors include stroke physician travel time to the hospital and decreased resources during after hours. Previous studies have shown that telestroke can be used to reduce door to treatment time in smaller rural hospitals without stroke expertise. Studies have not examined use of telestroke during after hours at a comprehensive stroke center.

We retrospectively reviewed all after hours (5pm-7am) stroke code activations from July 2016 to July 2017. During after hours, there is not typically a stroke specialist in the hospital. We initiated telestroke for after hours stroke codes starting January 2018 and all patients were included from initiation through March 2018. We collected the following time metrics for pre- and post-telestroke after hours cohorts: patient arrival, patient roomed, stroke code paged, neurologist call back, neurologist evaluation, CT interpretation, IV tPA, and recanalization. Baseline and telestroke timings were compared with Mann-Whitney U test.

Forty-five patients prior to telestroke initiation and twenty-one patients after telestroke initiation met inclusion criteria. Telestroke technology resulted in faster stroke code to neurologist at bedside (61 vs 18 minutes, p<0.001) and faster arrival to CT read times (41 vs 26 minutes, p = 0.003), but no significant change in any of the remaining time metrics, including time to treatment measures.

Telestroke significantly decreased time from stroke code activation to stroke specialist evaluation for after hours stroke codes. We did not find that faster patient evaluation resulted in faster tPA and thrombectomy times, but our study was likely underpowered to assess this endpoint. Further study is needed to determine whether telestroke improves time to treatment in this setting.