ABSTRACT NUMBER: ESOC2026A113 MOVING THE NEEDLE FOR THROMBOLYTIC AND TRANSFER DELAYS VIA TELESTROKE: A SURVEY OF STROKE REGISTRY HOSPITALS IN MICHIGAN

Abstract Background and aims Telestroke aims to provide rapid expert evaluation and evidence-based treatment to patients with acute ischemic stroke (AIS) in hospitals without on-site stroke specialists. However, intravenous (IV) thrombolysis and interhospital transfers are often delayed in telestroke-managed patients. We evaluated perceived drivers of these delays by surveying hospitals from a statewide acute stroke registry. Methods The Paul Coverdell Michigan Acute Stroke Registry (MASR) has collected stroke data since 2003 to measure and improve care. Currently MASR includes over 50 hospitals, representing 64% of the state’s stroke cases. Our team developed telestroke-specific questions for the 2025 MASR Hospital Inventory Survey, administered annually to hospital stroke program coordinators. We asked spoke sites (where telestroke call is initiated from) to identify the main causes of delay in 1) IV thrombolytic therapy delivery and 2) interhospital transfer when using telestroke. Results Of 53 MASR hospitals, 46 (87%) participated in the Inventory Survey. Of these, 18 were telestroke spoke sites. The top 3 identified sources of delay in thrombolytic therapy at the spoke sites were: determining patient eligibility (50%), obtaining consent (38.9%), and diagnosing stroke (22.2%). The top three sources of delay in interhospital transfer were: securing interhospital transport (44.4%), determining patient eligibility for transfer (27.8%), and identifying an accepting facility (22.2%). Conclusions A state-level stroke registry survey identified key perceived drivers of thrombolytic and transfer delays within telestroke systems. These results highlight modifiable targets to improve telestroke care and support future work incorporating diverse telestroke provider perspectives. Conflict of interest Brian Stamm: nothing to disclose. Ghada Ibrahim: nothing to disclose. Adrienne Nickles: nothing to disclose. Regina Royan: reported receiving a grant from the National Institute of Neurological Disorders and Stroke (K12NS137516) during the conduct of the study. Rodney Hayward: nothing to disclose. Mollie McDermott: nothing to disclose. Phillip Scott: reported receiving grants from NIH during the conduct of the study. Kevin Sheth: reported receiving grants from NIH during the conduct of the study; grants from Hyperfine, Genentech, and the American Heart Association; and personal fees from Astrocyte, Bexorg, and BrainQ outside the submitted work; and an issued patent for Alva. Mathew Reeves: nothing to disclose. Deborah Levine: reported receiving grants from NIH and consulting fees on NIH grants from Tufts University and Northwestern University outside the submitted work. Figure 1 - belongs to Conclusions