title: Timeliness of intravenous thrombolysis via telestroke in Georgia.
abstract: OBJECTIVE
  Through 2-way live video and audio communication, telestroke enhances urgent treatment of patients with acute stroke in emergency departments (EDs) without immediate access to on-site specialists. To assess for opportunities to shorten the door to thrombolysis time, we measured multiple time intervals in a telestroke system.
  
  
  METHODS
  We retrospectively analyzed 115 records of consecutive acute stroke patients treated with intravenous thrombolysis during a 20-month period via a statewide telestroke system in 17 EDs in Georgia. On the basis of times documented in the telestroke system, we calculated the time elapsed between the following events: ED arrival, telestroke patient registration, start of specialist consultation, head computed tomography, thrombolysis recommendation, and thrombolysis initiation.
  
  
  RESULTS
  The most conspicuous delay was from ED arrival to telestroke patient registration (median, 39 minutes; interquartile range, 21-56). Median time from ED arrival to thrombolysis initiation was 88 minutes, interquartile range 75 to 105. Thrombolysis was initiated within 60 minutes from ED arrival in 13% of patients.
  
  
  CONCLUSIONS
  The greatest opportunity to expedite acute thrombolysis via telestroke is by shortening the time from ED arrival to telestroke patient registration.
authors.affiliation: Department of Neurology, Georgia Regents University, Augusta, GA, USA. abruno@gru.edu
authors.forename: Askiel
authors.initials: A
authors.lastname: Bruno
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Lanning
authors.forename: Hartmut
authors.initials: H
authors.lastname: Gross
authors.forename: David C
authors.initials: DC
authors.lastname: Hess
authors.forename: Fenwick T
authors.initials: FT
authors.lastname: Nichols
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Switzer
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D005845:Georgia; D006801:Humans; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy; D017216:Telemedicine / Q000592:standards* / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy / Q000592:standards* / Q000706:statistics & numerical data; D013997:Time Factors
keywords: acute stroke; intravenous tissue-type plasminogen activator; ischemic stroke; stroke care; telemedicine; telestroke; thrombolysis