Time From Consult Page To Tissue Plasminogen Activator Treatment Over Telestroke Decreases With Experience

Introduction: Formal telestroke (TS) training for neurovascular fellows (NVFs) is necessary due to growing gaps in acute ischemic stroke (AIS) coverage, yet educational approaches are not well-characterized. Time between when a TS consultant is paged and tPA administration (page-to-needle time, PTNT) can provide an objective measure of proficiency in TS management of AIS. Hypothesis: We hypothesized that NVFs have longer PTNT than neurovascular attendings (NVAs), and PTNT improves with increasing number of TS consults. Methods: We identified suspected AIS patients in our TS registry (7/2013-6/2016) who received tPA while being evaluated remotely by video consultation at one of 17 spokes. Using multivariable quantile regression, we estimated the difference, and 95% confidence interval (CI) of the difference, for median PTNT between NVFs and NVAs. We also report the coefficient of change in PTNT over increasing number of TS consults. Results: Table 1 depicts baseline characteristics. NVFs evaluated 53.7% of 618 tPA cases over TS. NVAs took less time to administer tPA, difference in median PTNT (95% CI): -9 min (-12.3 to -5.7). This difference persisted when adjusted for relative tPA contraindications. For each additional TS consult, PTNT was decreased by 0.07 min for NVFs or NVAs (p=0.02 and <0.01, respectively) (Figure 1). Conclusion: TPA metrics improve with increasing number of TS consults for NVFs and NVAs. PTNT improves by 1 min for approximately every 14 TS consults. Our findings support the importance of integrating TS training into a supervised neurovascular fellowship to increase NVF proficiency in TS prior to independent practice.