Abstract Body: BACKGROUND: Primary stroke centers (PSC) lacking vascular neurologists are often challenged with evidence-compliant inpatient care. We determined impact of stroke fellowship educated nurse practitioners (NP) for PSC inpatient care.
METHODS: Stroke patients arriving at 3 PSCs were emergently evaluated by CSC vascular neurologists via telestroke; uncomplicated ischemic strokes were admitted/triaged by local hospitalists to either general neurologist (GN) or NP telestroke inpatient management. Demographics, medical management, complications, and core measure compliance data were analyzed.
RESULTS: A total of 1237 patients were managed by GN (n=720) and NPs (n=517) (Table). Sex, premorbid mRS (overall 0 [IQR 0-2]) and admission NIHSS (overall 2 [IQR 1-5]) were similar, however NP patients were younger (64.5+14 vs. 69+13; p<0.001) and more racially diverse (p=0.012). NPs managed most post-tPA patients (p<0.001), due to GN refusing management. Although hospital LOS was similar, NPs were more compliant with stroke mechanism work-up/documentation (p<0.001), utilized more long-term cardiac monitoring (p<0.001), had lower rates of post-stroke pneumonia (p=0.005), were more compliant with stroke core measures (statins p=0.009; NIHSS p<0.001), and had fewer new stroke readmissions within 30-days of discharge (p=0.027).
CONCLUSIONS: Implementation of stroke fellowship-educated NP telestroke inpatient management is feasible and improves stroke care quality in vascular neurology underserved PSCs.