Abstract Details

Title Implementing Telestroke in the Inpatient Setting: A Qualitative Analysis of Barriers and Facilitators

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-023

Objective To identify facilitators and barriers to the implementation of a multi-site inpatient telestroke program.

Background

Inpatient telestroke programs have emerged as a solution to providing timely stroke care in underserved areas, but the factors facilitating or inhibiting their implementation and effectiveness remain underexplored.

Design/Methods A hub-and-spoke inpatient telestroke program was established wherein inpatient stroke care for patients at five community sites (“spokes”) was managed virtually by providers at two distant comprehensive stroke centers (“hubs”). This inpatient telestroke program was evaluated through semi-structured qualitative interviews with sixteen inpatient providers (physicians and nurse practitioners) at spoke sites. The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided data analysis, focusing on four aspects of implementation: the innovation, recipients, context, and facilitation. Responses were coded inductively in NVivo using thematic analysis.

Results Fifteen themes were identified in the data and mapped to the i-PARIHS framework. Themes related to innovation (the telestroke program) included easy access to stroke specialists, the benefits of limiting patient transfers, concerns about duplicating tests, and challenges completing inpatient telestroke visits and documentation to facilitate timely discharge. Themes pertaining to recipients (care team members and patients) were communication gaps between teams, concern about the supervision of inpatient telestroke advanced practice providers, and challenges with nurse empowerment. With regards to the context (hospital and system factors), providers highlighted familiarity with telehealth technologies as a facilitator to implementing inpatient telestroke and described resource limitations in smaller facilities. Facilitation (program implementation) was recognized as crucial for education, standardization, and buy-in.

Conclusions

Understanding barriers and facilitators to implementation of our inpatient telestroke program can inform necessary adaptations that increase the likelihood of success and sustainability. Our findings may be broadly transferrable to the implementation of inpatient telestroke, teleneurology, and other subspecialty telemedicine programs.

Authors/Disclosures
Samuel Boes PRESENTER	Mr. Boes has nothing to disclose.
Solmaz Ramezani Hashtjin, MD	Dr. Ramezani Hashtjin has nothing to disclose.
Christopher Streib, MD (Department of Neurology)	Dr. Streib has nothing to disclose.
Maya Peters	No disclosure on file
Michael Usher	No disclosure on file
Joseph Koopmeiners	No disclosure on file
Timothy Beebe (University of Minnesota School of Public Health)	The institution of Timothy Beebe has received research support from NIH. The institution of Timothy Beebe has received research support from AHRQ.
Genevieve Melton-Meaux	Genevieve Melton-Meaux has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for American college of surgeons. Genevieve Melton-Meaux has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Utah, Ohio state university, and Washington University. Genevieve Melton-Meaux has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for American medical informatics association. The institution of Genevieve Melton-Meaux has received research support from NIH, AHRQ, PCORI, FDA.
Deborah Pestka	Deborah Pestka has nothing to disclose.

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