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. 2024 Jun;55(6):1517-1524.
doi: 10.1161/STROKEAHA.123.046024. Epub 2024 Apr 19.

Implementing Telestroke in the Inpatient Setting: Identifying Factors for Success

Deborah L Pestka  1 , Samuel Boes  2 , Solmaz Ramezani  2 , Maya Peters  1 , Michael G Usher  1 , Joseph S Koopmeiners  1   3 , Timothy J Beebe  1   4 , Genevieve B Melton  1   5   6 , Christopher D Streib  2
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Implementing Telestroke in the Inpatient Setting: Identifying Factors for Success

Deborah L Pestka et al. Stroke. 2024 Jun.

Abstract

Background: Inpatient telestroke programs have emerged as a solution to provide timely stroke care in underserved areas, but their successful implementation and factors influencing their effectiveness remain underexplored. This study aimed to qualitatively evaluate the perspectives of inpatient clinicians located at spoke hospitals participating in a newly established inpatient telestroke program to identify implementation barriers and facilitators.

Methods: This was a formative evaluation relying on semistructured qualitative interviews with 16 inpatient providers (physicians and nurse practitioners) at 5 spoke sites of a hub-and-spoke inpatient telestroke program. The Integrated-Promoting Action on Research Implementation in Health Services framework guided data analysis, focusing on the innovation, recipients, context, and facilitation aspects of implementation. Interviews were transcribed and coded using thematic analysis.

Results: Fifteen themes were identified in the data and mapped to the Integrated-Promoting Action on Research Implementation in Health Services framework. Themes related to the innovation (the telestroke program) included easy access to stroke specialists, the benefits of limiting patient transfers, concerns about duplicating tests, and challenges of timing inpatient telestroke visits and notes to align with discharge workflow. 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 regard to the context (hospital and system factors), providers highlighted familiarity with telehealth technologies as a facilitator to implementing inpatient telestroke, yet highlighted 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 is crucial to determining where programmatic changes may need to be made to ensure the success and sustainment of inpatient telestroke services.

Keywords: implementation science; inpatients; ischemic stroke; stroke; thrombectomy.

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Conflict of interest statement

Disclosures Dr Melton is a fiduciary officer for the American College of Medical Informatics, the American Medical Informatics Association, and the President and Chair of the Board of Directors at Fairview Health Services. She is the Chief Analytics and Care Innovation Officer at the University of Minnesota, and she is a consultant at Washington University School of Medicine in St. Louis. She has grants with the Agency for Healthcare Research and Quality, the Food and Drug Administration, the National Institutes of Health, and the US Department of Defense. The other authors report no conflicts.

References