Abstract 2991: Utilization Of A Statewide Telestroke Network And Sustainability Over Time - The Michigan Stroke Network Experience

Introduction: Telemedicine for patients with acute stroke represents a method to extend neurologic expertise to hospitals without established Stroke Teams. The Michigan Stroke Network (MSN) is a comprehensive telestroke service providing emergency stroke consultations at 34 spoke hospitals throughout Michigan since 2007. Several non-member health systems also contribute patients to the hub, St. Joseph Mercy Oakland Hospital (SJMO) in Pontiac, MI. Maintaining a large telestroke network is a demanding practice due to the geographic coverage, multidisciplinary communication, need for precision in remote neurological examination and PACS viewing, and rapid and complex decision making. Objective: To evaluate the sustainability of a statewide telemedicine stroke network. Results: Telestroke utilization data from 2008-2011 were prospectively collected from MSN member hospitals and are provided in the attached table. Patients were more likely to be transferred if endovascular intervention was planned. Although the percentage of transferred patients for intervention decreased somewhat over time, this likely reflects improved efficiency of triaging appropriate revascularization candidates. Conclusions: Our results demonstrate the feasibility of maintaining a large statewide telemedicine network. The steady call volumes demonstrate the value of facilitated acute stroke decision making at hospitals without established Acute Stroke Teams. The turnaround time for the consultant and time for robot activation remained stable. Consult duration was slightly increased in 2011 as compared to prior years. A substantial number of patients were candidates for acute stroke intervention each year. On average, patients receiving IV-tPA through MSN experienced a >7-point reduction in NIHSS by the end of their hospital stay. 30-day follow-up NIHSS/mRS were not available at the time of this analysis.