title: Improving Telestroke Treatment Times in an Expanding Network of Hospitals.
abstract: BACKGROUND
  Like all medical innovations, telestroke must demonstrate successful outcomes to achieve sustained growth and acceptance. Asserting that telemedicine is faster, employs the latest technology, or promotes a better use of limited resources is laudable but insufficient. An analysis of stroke treatment within a telemedicine network in 2013 showed that tissue-type plasminogen activator (tPA) could be safely and reliably administered within a practice-based model of telestroke care. Since then, hospital volume and tPA administration within this network have tripled. We hypothesize that a practice-based model of telestroke can maintain positive outcomes in the face of rapid growth.
  
  
  METHODS
  Data on tPA treatment times and outcomes after thrombolysis were gathered for 165 patients treated with alteplase between November 2012 and November 2014. Comparisons were made to a previous published study of 54 patients seen between October 2010 and October 2012 in the same network. Primary outcome measures were average door-to-needle (DTN) time for TPA administration and average call-to-needle (CTN) time.
  
  
  RESULTS
  Significant reductions were observed in median DTN (93 versus 75 minutes, P < .01) and median CTN (56 versus 41 minutes, P < .01). Quality outcome measures such as post-tPA symptomatic hemorrhage (2 [4%] versus 9 [5%], P = .23), length of stay (4 versus 4 days, P = .45), mortality (8 [15%] versus 16 [10%]; P = .32), and percentage of stroke patients treated remained stable.
  
  
  CONCLUSIONS
  This study shows that a practice-based telemedicine system can produce meaningful improvement in markers of telestroke efficiency in the face of rapid growth of a telestroke network.
authors.affiliation: AcuteCare Telemedicine, LLC, Atlanta, Georgia. Electronic address: Keith.Sanders@acutecaretelemed.com.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Sanders
authors.affiliation: AcuteCare Telemedicine, LLC, Atlanta, Georgia.
authors.forename: Rahul
authors.initials: R
authors.lastname: Patel
authors.affiliation: AcuteCare Telemedicine, LLC, Atlanta, Georgia.
authors.forename: James M
authors.initials: JM
authors.lastname: Kiely
authors.affiliation: AcuteCare Telemedicine, LLC, Atlanta, Georgia.
authors.forename: Matthews W
authors.initials: MW
authors.lastname: Gwynn
authors.affiliation: AcuteCare Telemedicine, LLC, Atlanta, Georgia.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Johnston
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D020521:Stroke / Q000188:drug therapy*; D017216:Telemedicine; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Call-to-needle (CTN) time; door-to-needle (DTN) time; stroke mimic; telemedicine; telestroke; tissue-type plasminogen activator (tPA)