To study the impact of standard-of-care inpatient telestroke evaluation on transfer rates and stroke specialist access.

Of 800,000 strokes per year in the United States, approximately 25% are recurrent. Stroke specialist evaluation with targeted secondary prevention reduces recurrent stroke risk, but access is limited, especially in rural areas. We evaluated feasibility of inpatient telestroke consultation to reduce transfer rates and increase stroke specialist evaluation rates for AIS patients within our telestroke network.

We assessed AIS care at five “spoke” hospitals between 1/1/21–12/31/23. Pre-intervention, all hospitals had telestroke coverage in emergency departments, protocolized stroke admission order sets, and stroke specialists at the “hub” available to provide guidance 24/7 via telephone consultation and chart review. Inpatient telestroke consultation by stroke specialists at the hub site was implemented sequentially in a phased rollout. Telestroke specialists guided the diagnostic stroke evaluation and secondary stroke prevention. A multivariable logistic regression model incorporating the stepped-wedge cluster design was utilized to  compare  rates of transfer and access to a stroke specialist pre- and post-intervention.

1,295 total AIS patients were included (537 and 758 pre- and post-inpatient telestroke implementation, respectively, median age 75.24 [IQR: 64.45-86.11], 47.7% female, 92.2% white, and median NIHSS 2 [IQR:0-5]). Transfer rates pre- and post-inpatient telestroke implementation were 58.5% and 37.5%, (adjusted p-value<0.01). Within specific transfer indications, stroke specialist evaluation (7.4% vs 0.9%) and higher level stroke center (27.6% vs 18.3%) showed the most absolute reduction. Stroke specialist consultation rate increased from 80.2% to 96.4% (adjusted p-value < 0.01). Similarly, stroke consultation became increasingly comprehensive (full telestroke consultation 1.4% versus 94.1%).