Abstract TP017: Impact of Neurology Access on 30-Day Stroke Mortality in Community Emergency Departments

Objectives: Emergency Departments (EDs) across the US vary widely in resources and availability of specialty consultation. Access to neurology expertise during acute stroke care may influence treatment decisions that impact patient outcomes. We investigated whether hospital-level differences in Neurology access during ED stroke codes were associated with hospital performance on 30-day stroke mortality rates. Methods: We used data from EDs participating in the Emergency Quality Network (E-QUAL) Stroke Collaborative between 2022 and 2024, linked to CMS data for 30-day stroke mortality reported as of June 30, 2023. The primary independent variable was Neurology access during ED stroke code activation, categorized as: in-person, telestroke, or phone/no Neurology. We performed descriptive analysis and linear regression to examine the relationship between Neurology access and 30-day stroke mortality, adjusting for ED annual stroke volume, rurality, participation in a stroke registry, and disposition practices for thrombolysis-treated patients. Results: Among the 52 EDs, Neurology was available during a stroke code in person for 48.1% of EDs, by telestroke for 38.4%, and by phone or not at all for 13.5%. Mean 30-day stroke mortality was 13.1% (standard deviation SD 1.7%) for EDs with in-person Neurology, 14.0% (SD 1.8%) for telestroke, and 15.2% (SD 1.2%) for phone/no Neurology (Figure). In both unadjusted and adjusted analyses, EDs with phone/no Neurology had higher 30-day stroke mortality compared to in-person access (adjusted: +1.7%, p = 0.02), while 30-day mortality for EDs with telestroke was not significantly different from in-person Neurology (Table). Independent of neurology access, rural EDs had higher stroke mortality compared to non-rural EDs (adjusted: +2.8%, p = 0.006). Stroke volume, participation in a stroke registry, and disposition of thrombolysis-treated patients were not significantly associated with mortality. Conclusion: Limited access to Neurology expertise during ED stroke codes was associated with higher 30-day stroke mortality for community hospitals. However, consistent with prior research, EDs with telestroke demonstrated comparable outcomes to EDs with in-person Neurology. These findings underscore the importance of addressing gaps in access to Neurology expertise in community EDs for ensuring optimal stroke outcomes for all patients and highlight the value of telestroke as a tool to do so.