Abstract TP223: Nurse-Driven Telestroke Program Customization

Background and Issues: Advancements in telestroke are critical in promoting increased access to care. However, telestroke can present workflow or logistical hurdles that can potentially lengthen treatment times if not executed properly. The need for a cohesive partnership between hospitals and their telestroke service is increasingly evident to improve outcomes in stroke patients. Purpose: This quality improvement project aimed to strengthen the partnership between telestroke and the client hospital by developing a customizable nurse-led toolkit for tracking and measuring thrombolytic usage and outcomes in the emergency department. The initiative was led by the nurse coordinator at the telestroke practice, along with the hospital stroke coordinator at the primary stroke center. Methods: Key components of the toolkit included a roadmap checklist outlining the facility’s goals for their stroke program at specific checkpoints, a patient tracker capturing door-to timestamps for each workflow step, and a tailored case review timeline for intravenous thrombolytic recipients. Baseline data was collected from January 1st through August 31st, 2024. Plan-Do-Study-Act (PDSA) cycles were then used to test the intervention between September 1st, 2024 and July 31st, 2025. Regular meetings were established to collaborate on workflow and review progress. A survey was conducted before and after the intervention period to determine the hospital’s level of engagement with the telestroke clinical operations team. Results: There was no decrease in mean door-to-needle (DTN) times pre- and post-intervention (78 minutes). However, treatment rates increased by 27% during the intervention period compared to pre-intervention (2.9 versus 2.25 treated patients per month). Surveys demonstrated a 32% increase in the hospital’s engagement with the telestroke clinical operations team. Conclusion: Implementing a customized stroke program toolkit can strengthen the clinical quality relationship between telestroke and the hospital team, and can contribute to increased thrombolytic treatment rates. While no reduction in mean DTN time was achieved, the findings support the importance of a nurse-driven, customized approach to stroke care in the evolving telestroke arena.