Telestroke Program Participation and Improvement in Door-To-Needle Times

Background: Telestroke can provide indispensable expert stroke care for rural hospitals. The Stroke Telemedicine for Arizona Rural Residents program was developed in 2006 by Mayo Clinic to provide stroke expertise across the region. However, little data currently exist to determine whether this telestroke program had an impact on accepted acute stroke care metrics, such as door-to-needle time. Hypothesis: Participation of spoke sites in a telestroke program improves stroke care over time, as defined by currently accepted metrics, such as door-to-needle time. Methods: A retrospective analysis was performed on the telestroke database from Mayo Clinic Arizona between the years of 2011 to 2018. All patients with a diagnosis of acute ischemic stroke, who underwent a telestroke consultation and received intravenous alteplase were included in the analysis. Univariate linear regression was performed to look for associations between variables and defined outcomes. Results: A total of 563 patients were identified who met inclusion criteria. Average last-known normal to needle times decreased across all telestroke participating spoke sites from 176 to 147 min, with univariate linear regression showing a trend of decreased time of 3.4 min per year, which was statistically significant (p = 0.0042). Average door-to-needle times decreased from 112 to 81 min, with univariate linear regression modeling showing a decreasing trend of 3.7 min per year (p < 0.0001). Conclusions: Telestroke network participation may be associated with improved acute stroke care metrics over time, with the analysis illustrating improved last-known normal to needle and door-to-needle times among participating spoke sites.