Abstract Body: Purpose: Decreasing door to needle and door to transfer times drives patient outcomes. When treating acute stroke patients, time is brain. The shorter the door to treatment time the faster patients can receive the thrombolytic therapy. The rapidly evolving use of telemedicine in acute stroke is state-of-the-art for identifying therapeutic indications such as IV thrombolysis and mechanical thrombectomy in patients with large vessel occlusion (LVO) (Schröter et al., 2023).

Method: Our facility is a Joint Commission certified Primary Stroke Center with two Acute Stroke Ready certified freestanding emergency departments (ED), caring for >67,000 patients a year with >700 being diagnosed with stroke. In 2023 our EDs transferred 35 patients with an LVO and 21 year to date in 2024.

A review of data illustrated an opportunity with our teleneurology program, staffed by an internal team of neurologists from our comprehensive stroke center. The development of the teleneurology program began at our health system in March 2021. ED providers had the ability to consult teleneurology, via telephone or video consult. When first launched, the new process was inconsistent.

Through ongoing chart audits, we identified ED providers were reliant on the recommendations from the teleneurologists. Upon review, a barrier to care was identified which caused delays in door to decision. In November 2023, we implemented a new stroke alert process, mandating that all stroke alert activations automatically received a teleneurology consult. By refining the process, we have demonstrated improvements in our door to needle and door to transfer times. Since the therapeutic success is strongly dependent on time, an early, accurate decision-making process is essential for timely transfer of the patient to a mechanical thrombectomy-competent center for appropriate stroke-oriented imaging and therapy (Schröter et al., 2023).

Results: Post-implementation, our door in door out times decreased by 20% within eight months. Our median door in door out time decreased by 22.5 minutes. Of the LVO's we have transferred, five patients were transferred in <60 minutes and two patients in <70 minutes. Additionally, we have seen an overall reduction in our door to needle times.

Discussion: Moving forward, we will continue to review and refine our workflows. There is consideration adding a nurse to the teleneurology team and a dedicated stroke response nurse to the team to provide additional support to our program.