Study: 'Door-to-needle' time drops 20 minutes with telestroke

A telestroke program introduced at Oakland, Calif.-based Kaiser Permanente streamlined the health system's stroke care across 21 hospitals, according to a study published in Stroke.

In 2015, Kaiser Permanente's Northern California Health Care division redesigned its acute stroke workflow, mandating a dedicated telestroke neurologist manage all emergency stroke cases across its 21 hospitals. For the study, researchers compared stroke outcomes of 310 patients treated before the program went into effect against outcomes of 557 patients treated after its implementation.

The primary outcome the researchers considered was the elapsed before a patient received alteplase medication, also known as the "door-to-needle" time. After Kaiser Permanente implemented the telestroke program, the health system's median DNT time dropped from 53.5 minutes to 34 minutes. The researchers found 87.1 percent of cases experienced a DNT time of fewer than 60 minutes with telestroke, compared to only 61 percent of cases beforehand.

The researchers also considered rates of complications following stroke treatment, such as symptomatic intracranial hemorrhage. They determined there was no difference in the rates of symptomatic intracranial hemorrhage before and after the program's implementation.

The study authors concluded the program was associated with "increased alteplase administrations, significantly shorter DTN times and no increase in adverse outcomes."

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