Abstract Details

Title Downstream Impact of an Inpatient Telemedicine-based Stroke Care Delivery Model

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-001

Objective

This ancillary study investigates the downstream impact on stroke census, transfer rate, and length of stay during the TELECAST study (NCT03672890).

Background

TELECAST compared two inpatient stroke care delivery models at a single, community-based acute stroke ready hospital. In the “in-person” model, inpatient stroke care was delivered conventionally by local general neurologists; in the “telestroke” model, inpatient stroke care was delivered exclusively via telestroke by vascular neurologists at a remote comprehensive stroke center. Adherence to guideline-based acute ischemic stroke (AIS) care was higher in the telestroke model.

Design/Methods All adult AIS patients treated under the in-person model (July 1, 2016-June 30, 2018) and the telestroke model (July 1, 2018-June 2019) were included in this study. Patient demographics and outcomes were abstracted from the Get with the Guidelines Stroke Database and electronic medical record. Wilcoxon Rank Sum and chi-squared tests were utilized as indicated. Statistical analysis was conducted using STATA 15.0.

Results In total, 341 AIS patients (median age 70 [IQR 59-80], female 41.6%, median NIHSS 1 [IQR 0-3]) were treated during the two-year in-person phase and 274 AIS patients (median age 72 [IQR 61-81], 54.1% female, median NIHSS 2 [IQR 0-4]) were treated during the one-year telestroke phase. During the telestroke phase, transfer rates were lower (25.2 vs 42.8%, p<0.01) and the length of stay was shorter (median 47.8 hours [IQR 28.4-78.3] vs 65.3 hours [IQR 42.3-99.2], p<0.01) than in the in-person phase.

Conclusions

Inpatient stroke care provided by remote stroke specialists utilizing telestroke was associated with a higher AIS patient census, lower transfer rate, and shorter length of stay. These findings may further inform optimal stroke care delivery models for acute stroke ready hospitals.

Authors/Disclosures
Solmaz Ramezani Hashtjin, MD PRESENTER	Dr. Ramezani Hashtjin has nothing to disclose.
Shayan Khan (university of minnesota)	No disclosure on file
Adam R. Lipschultz, MD (University of Minnesota)	Dr. Lipschultz has nothing to disclose.
Savannah Novy, MD	Ms. Novy has nothing to disclose.
Cynthia Zheng	Ms. Zheng has nothing to disclose.
Monica Ngo, MD (University of Minnesota Medical School - Twin Cities)	Dr. Ngo has nothing to disclose.
Kathryn Bard, PA	Ms. Bard has nothing to disclose.
Sarah A. Engkjer, RN (Minnesota Epilepsy Group)	No disclosure on file
Christopher Streib, MD (Department of Neurology)	Dr. Streib has nothing to disclose.

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