Abstract W P217: Improvement of Door to Needle Times and IV rt-PA Utilization with the Application of TARGET:STROKE Recommendations to an Urban Integrated Tele-Medicine System

Background and Objectives: Tele-medicine (TM) has been proven to provide quality acute stroke care. The type of consultation and services provided by TM vendors vary. None seem to provide a comprehensive service to the receiving center that includes methods on how to improve door to needle times (DTN). We hypothesized that creating a comprehensive TM solution in an integrated medical system using TARGET: STROKE (TS) principles would improve DTN times and IV rt-PA utilization. Methods: Five urban Joint Commission certified primary stroke center community hospitals in a Southern California integrated healthcare system participated. Prior to initiation of TM services, each hospital had two separate meetings with the TM provider (two vascular neurologists). The first meeting was with emergency room physicians, explaining the need to have a low threshold to call a tele-code stroke within 4.5 hours of last seen normal regardless of inclusion/exclusion criteria and prior to obtaining the head CT. The second meeting included a multi-disciplinary group to outline the TS principles and organize a stroke team with a focused goal to improve DTN. The 10 TARGET: STROKE best practice strategies were implemented. Data regarding the key time interval goals were gathered and reviewed with each hospital on a bi-weekly basis. The TM providers worked with each hospital to improve specific time intervals where necessary by providing proven strategies, and assisting in their implementation. Data were analyzed using a parallel time period at each hospital comparing pre-TM to post-TM, the longest period being 11 months. Results: Twenty-eight patients were given rt-PA pre-TM compared to 50 patients post-TM. The percent of patients who received rt-PA ≤ 60 minutes (min) pre-TM was14% vs. 42% post-TM (p=0.02). The median pre-TM DTN was 78 min (IQR 68-116) compared to a post-TM DTN of 67 min (IQR 56-78), an absolute difference of 11 min (p=0.007). Conclusion: Application of TARGET: STROKE guidelines can be implemented successfully via an integrated TM system of stroke care to improve DTN and rt-PA utilization.