Abstract Body: Background: The University of Arkansas for Medical Sciences (UAMS) Institute for Digital Health & Innovation (IDHI) – Telestroke Program provides neurology support to 62 spoke hospitals across Arkansas. We retrospectively reviewed stroke consults who received Alteplase or Tenecteplase during the 2023 calendar year, to determine if years of program training influences time metrics. We examined Door to CT (Door2CT) and Door to Lytic (Door2Lytic) time with spoke hospital size and the year the spoke joined the telestroke program.
Methods: Sixty-two Spoke hospital sites joined the telestroke program from 2008 to 2023 and were determined as veteran (2008 to 2018) or recently joined (2019 to 2023). Spoke hospital size was determined as bed size and included 0-25, 26-50, 51-100, 101-150, 151-200 and >200 beds. Both time metrics of Door2CT and Door2Lytic from calendar year 2023 were examined by both the year spoke hospitals joined and bed size using ANOVA.
Results: Door2CT times were significantly faster at p=0.01, with improved times to CT by veteran hospital sites compared to recently joined sites (15.1±0.8 from sites who joined in 2008-2018 vs. 19.6±2.4 who recently joined 2019-2023, p=0.042, respectively). Door2Lytic minutes were also significant comparing veteran spoke hospitals to more recently added sites, (60.3±1.2 veteran sites vs. recently joined sites 66.8±3.5, p=0.041, respectively). Hospital size was not significant in Door2CT minutes at p=0.20; however the D2Lytic was significantly improved in the midsize spoke hospitals (51-100 and 151-200 size groups) that were comprised of veteran hospital sites, p=0.0002.
Conclusion: Regardless of hospital size in a large telestroke system, veteran sites performed better in CT and lytic time metrics.