Key result
The Victorian Stroke Telemedicine program increased thrombolysis provision (37% vs 30%) and reduced symptomatic intracerebral hemorrhage (4% vs 16%) and in-hospital mortality (6% vs 20%).
Why the study?
The study was conducted to evaluate the impact of the Victorian Stroke Telemedicine program during its first 12 months on the quality of acute stroke care in regional hospitals.
Does a telemedicine program improve the timeliness of care and clinical outcomes in adult patients with suspected acute stroke presenting to regional hospitals?
Cohort (n=6,065)
Yes
Does a telemedicine program improve the timeliness of care and clinical outcomes in adult patients with suspected acute stroke presenting to regional hospitals?
Absolute Event Rate: 37% vs 30%
Implementation of a stroke telemedicine program in regional hospitals significantly reduced door-to-needle times and was associated with lower rates of symptomatic intracerebral hemorrhage and in-hospital mortality.
VST-associated care gains in regional hospitals may support targeted expansion; leaves open need for RCTs to confirm outcome benefits.
OBJECTIVES: To evaluate the impact of the Victorian Stroke Telemedicine (VST) program during its first 12 months on the quality of care provided to patients presenting with suspected stroke to hospitals in regional Victoria. DESIGN: Historical controlled cohort study comparing outcomes during a 12-month control period with those for the initial 12 months of full implementation of the VST program at each hospital. SETTING: 16 hospitals in regional Victoria that participated in the VST program between 1 January 2010 and 30 January 2016. PARTICIPANTS: Adult patients with suspected stroke presenting to the emergency departments of the participating hospitals. MAIN OUTCOME MEASURES: Indicators for key processes of care, including symptom onset-to-arrival, door-to-first medical review, and door-to-CT times; provision and timeliness of provision of thrombolysis to patients with ischaemic stroke. RESULTS: 2887 patients with suspected stroke presented to participating emergency departments during the control period, 3178 during the intervention period; the patient characteristics were similar for both periods. A slightly larger proportion of patients with ischaemic stroke who arrived within 4.5 hours of symptom onset received thrombolysis during the intervention than during the control period (37% v 30%). Door-to-CT scan time (median, 25 min [IQR, 13-49 min] v 34 min [IQR, 18-76 min]) and door-to-needle time for stroke thrombolysis (73 min [IQR, 56-96 min] v 102 min [IQR, 77-128 min]) were shorter during the intervention. The proportions of patients who received thrombolysis and had a symptomatic intracerebral haemorrhage (4% v 16%) or died in hospital (6% v 20%) were smaller during the intervention period. CONCLUSIONS: Telemedicine has provided Victorian regional hospitals access to expert care for emergency department patients with suspected acute stroke. Eligible patients with ischaemic stroke are now receiving stroke thrombolysis more quickly and safely.
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Bladin et al. (2020) conducted a cohort in suspected stroke (n=6,065). Victorian Stroke Telemedicine (VST) program vs. Historical control period was evaluated on Provision of thrombolysis to patients with ischaemic stroke arriving within 4.5 hours of symptom onset. The Victorian Stroke Telemedicine program increased thrombolysis provision (37% vs 30%) and reduced symptomatic intracerebral hemorrhage (4% vs 16%) and in-hospital mortality (6% vs 20%).
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