Abstract Background and aims The CATI Network was launched in 2019 to provide equitable, specialist-led acute stroke care 24/7 in Andalucia, regardless of on-site neurologist availability. Since its implementation, the network has progressively grown. However, this growth has also been accompanied by increasing clinical workload and organisational complexity. Methods We analysed activity between 2019-2025, including monthly activation volumes, network expansion, temporal distribution of consultations, and simultaneous case management. Over this period, it provides real-time support to 38 hospitals. In addition to its initial focus on intravenous thrombolysis, the network progressively incorporated advanced responsibilities, including thrombectomy candidate selection, urgent review of advanced neuroimaging and extended time-window treatments. Workload indicators included total activations, growth rates, hourly distribution, and frequency of simultaneous active cases. Results CATI activity increased with a cumulative growth of +74% between 2020-2022 (2020: 842consultations, 2023:1468consultations) and a further +78% between 2024-2025 (2025:3027consultations). In 2023, increasing workload required conversion of the on-call system to a full on-site duty model. Nevertheless, during 2024–2025, ≥2 simultaneous active stroke cases occurred on 61.9% of days, ≥3 cases on 13.5%, and ≥4 cases on 1.45%. Peak activity was observed between 10:00-23:00, particularly 11:00-19:00, with no low-activity periods overnight. This pattern reflects sustained simultaneity rather than isolated peaks. Conclusions As a large, centralised telestroke network matures, workload and case simultaneity increase and become organisational challenges. Describing these patterns helps guide planning and supports practical adjustments in resources and organisation to maintain patient safety, equity, and long-term sustainability as the network continues to grow. Conflict of interest Nothing to disclose
Barragán et al. (Fri,) studied this question.