Intravenous tissue plasminogen activator administration in community hospitals facilitated by telestroke service

Abstract

Background: Stroke is a leading cause of death and disability in the United States. Despite the proven benefits of intravenous tissue plasminogen activator (IV-tPA), only a small percentage of patients who have had a stroke (3.4%-5.2%) receive this US Food and Drug Administration-approved therapy.

Objective: To prospectively assess the impact of a telestroke network on the rate of IV-tPA administration in patients with acute ischemic stroke in community hospitals.

Methods: Thomas Jefferson University Hospital has developed a telestroke system providing acute stroke care in 28 community hospitals within the region (Pennsylvania, New Jersey, and Delaware). Telemedicine consultations are delivered through Remote Presence robotic technology.

Results: A total of 1643 telemedicine stroke consultations were provided between January 2011 and June 2012. The mean interval from consultation request to telemedicine response was 12.0 minutes. The overall rate of IV-tPA use was 14% among all stroke consultations. A total of 237 patients (14.4%) were determined to be eligible for intravenous thrombolysis. Of those, 97% received IV-tPA. Most hospitals (82%) within the telemedicine program reported an increase in IV-tPA use (mean increase, 55%). The proportion of patients transferred to a primary stroke center after teleconsultation decreased from 44% in the first 2 quarters of 2011 to 19% in the first 2 quarters of 2012 (P < .001).

Conclusion: Implementing a telestroke system facilitates high rates of intravenous thrombolysis in patients who have had a stroke in community hospitals within a relatively short time frame. These results are higher than the national average rate (3.4%-5.2%) and support the implementation of telestroke networks for wider access to stroke expertise in underserved regions.