Frequent Hub–Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network

摘要

>Background: For acute ischemic stroke patients, shorter time to thrombolytic (tissue plasminogen activator [tPA]) is associated with improved outcomes.>Introduction: Telestroke increases tPA use at spoke hospitals, yet its effect on door-to-needle (DTN) times for tPA administration is unknown. We hypothesize that spoke hospitals with more frequent contact to a hub hospital will have shorter DTN times than those with less frequent contact.>Materials and Methods: We identified 375 patients treated with tPA by conventional or telestroke methods in an academic hub-and-spoke telestroke network for whom date and time data were available. Strength of the spoke–hub connection was the primary predictor variable, defined as the number of all telestroke consults (tPA and non-tPA) done at each spoke hospital during the year of the patient's presentation. Patient-level regression analyses examined the relationship between DTN time and spoke–hub connection during the year of the patient's presentation, controlling for temporal trends and clustering within hospitals.>Results: Sixteen spoke hospitals contributed data on 375 tPA-treated patients from 2006–2015. Hospitals treated a median of 13.5 patients with tPA per year; median hospital-level DTN was 78.8 min (interquartile range [IQR] 71.3–85). Median number of telestroke consults per year was 34 (range 3–137). Among all 375 patients, median DTN was 76 min (IQR 60–97). Strength of spoke–hub connection was significantly associated with faster DTN time for patients (1.3 min gain per 10 additional consults, p = 0.048).>Conclusions: More frequent contact between a telestroke spoke and its hub was associated with faster tPA delivery for patients, even after accounting for secular trends in DTN improvements.