Abstract TP227: Implementing a Telephone Triaging System Improves Thrombolysis Treatment Times in the Northwestern Medicine Telestroke Program

Acute stroke is the fifth leading cause of death and a leading cause of disability in the United States. Timely treatment with intravenous thrombolytics such as tenecteplase (TNK) within 4.5 hours of last known well (LKW) and endovascular thrombectomy within 24 hours of LKW can significantly improve patient outcomes, when appropriate. Many hospitals rely on telestroke partnerships to provide expert evaluation and treatment of patients presenting with acute ischemic stroke symptoms. The Northwestern Medicine (NM) Telestroke Program previously conducted telestroke consultations following imaging acquisition and did so by going directly to a video evaluation. We hypothesized that changing the workflow to engage telestroke earlier in the emergency department (ED) stroke code process wherein telestroke consultation was activated immediately following the ED physician’s initial evaluation of the patient and before or during emergent stroke imaging via an immediate provider-to-provider telephone discussion of the relevant details of the patient’s presentation including, but not limited to, neurologic deficits, LKW, and anticoagulant use, would lead to improved TNK treatment times for eligible patients presenting with acute stroke symptoms to the ED of hospitals within our program. Methods: We started with a pilot site of one hospital in our program to ensure feasibility of this workflow changes and collect short-term information on door to consult (DTC) times, door to needle (DTN) times, and door-in-door-out (DIDO) times. After a 3 month pilot, we implemented this workflow change across the NM Telestroke Program at large. We compared historical data across all telestroke sites prior to the intervention to data collected after the intervention. We measured door to consult times, door to needle times, and door-in-door-out times before and after this process change. Results: When this process change was implemented across the NM Telestroke Program, there was a 50% decrease in time to emergent neurology consultation, a decrease of 17.4% in time to TNK treatment, and a 9.5% decrease in transfer times to a comprehensive stroke center (CSC). Conclusions: A large-scale change in telestroke workflows is a feasible task. A telestroke consultation process that emphasizes early activation of telestroke services, even before imaging is obtained, and leads with a triaging telephone discussion before video evaluation leads to faster acute ischemic stroke interventions.