A new study on telestroke workflow changes finds that the difference between stroke patients who receive treatment within 60 minutes and those who do not often comes down to protocol decisions, including the ones made before the patients arrive.

The peer-reviewed study examined three specific telestroke workflow changes and quantified that gap by drawing from data across 79 hospitals and 14 states within the TeleSpecialists network. The research was published in Telemedicine Reports.

The study also measured the independent impact of all three workflow changes on door-to-needle (DTN) times and thrombolytic treatment rates. EMS pre-notification reduced door-to-needle times by eight minutes and increased treatment rates by 3.7 percent.

Early initiation of intravenous thrombolytics (IVT) in cases of acute ischemic stroke (AIS) leads to improved functional outcomes, decreased IVT-related complications, and lower stroke mortality rates, according to the study.

Guidelines published by the American Heart Association/American Stroke Association aim to minimize DTN times in both pre-hospital and emergency department (ED) settings, aligning with the “Get With The Guidelines—Stroke (GWTG—Stroke)” recommendations. However, these protocols are primarily tailored to institution protocols for in-person acute stroke assessment.

The findings were significant: Hospitals with EMS pre-notification in place achieved door-to-needle times under 60 minutes in 87.9 percent of cases. That figure was 67.7 percent among those without it. Neurologist evaluation conducted in the CT imaging suite reduced times by an additional six minutes and improved treatment rates by 1.46 percent. IV thrombolytic administration in the CT suite saw a further three-minute reduction and a 2.87 percent improvement in treatment rates.

As of 2019, ∼45% of EDs relied on telestroke services for acute ischemic stroke (AIS) evaluation, which covers almost 90% of the U.S. population. Similar findings were observed in Europe,  especially in rural areas, where there has been a steady increase in the number of telestroke networks. Telestroke has been proven to deliver high-quality and safe AIS care regardless of the geographic location or local infrastructure.

Each protocol change examined in the study represented a workflow decision available to any hospital operating a telestroke program, regardless of the size of the facility or where it is located. The research documents what improvement looks like at scale, across hospitals with varied resources and patient volumes, and establishes a reproducible evidence base for stroke programs evaluating their current protocols, TeleSpecialists said.

“These findings highlight what innovation and collaboration can accomplish for patients. By working closely with our clinical partners and regional EMS agencies, we implemented three workflow improvements that delivered life-saving stroke treatment to more patients in less time. Faster treatment leads to better outcomes, and these results reinforce the value of a coordinated approach to stroke care,” said Jacob Sambursky, M.D., director of clinical research and regional medical director, TeleSpecialists.

The physician-owned digital healthcare system provider has delivered comprehensive teleneurology and telepsychiatry services to more than 1.5 million patients across emergency, inpatient, and outpatient settings since its founding in 2014. Its TeleStroke service line operates across more than 400 partner hospitals nationwide. The organization’s physician-designed quality program supports ongoing protocol development, outcome measurement, and clinical education across its partner network.