Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

The New South Wales Telestroke Service: Access, Treatment and Outcomes. (#99)

Ken Butcher 1 , Carlos Garcia‐Esperon 2 , Kelly Andersen 3 , Bill O'Brien 4 , Fiona Ryan 3 , James Evans 4 , Tim Ang 5 , Jenni Steel 6 , Leon Edwards 4 , Chris Blair 4 , Alvin Chew 2 , Candice Delcourt 7 , Amanda Buzio 6 , Kim Hoffman 8 , Donna Jay 9 , Rachel Peake 10 , Debra Sloane 11 , Thembe Mathe 10 , Cecelia Duley 8 , Katherine Mohr 12 , Jaclyn Birnie 10 , Kristine Caprecho 13 , Neil Spratt 2 , Mark Parsons 1 , leanne bryant 6 , Andrea Thatcher 6 , Emily Mackinlay 14 , Claire Gill 14
  1. UNSW, Randwick, NSW, Australia
  2. Neurology, University of Newcastle and Hunter New England Health Region, Newcastle, NSW, Australia
  3. Stroke Network, Agency For clinical Innovation, Sydney, NSW
  4. Neurology, Gosford Hospital, Gosford, NSW
  5. Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  6. Mid North Coast Local Health District, Port Macquarie, NSW
  7. Stroke, The George Institute, Camperdown, NSW , Australia
  8. Northern NSW Health District, Lismore, NSW
  9. Illiwarra Shoalhaven Local Health District, Nowra, NSW
  10. Hunter New England Local Health District, Tamworth, NSW
  11. Western NSW Local Health District, Dubbo, NSW
  12. Murrumbidgee Local Health District, Wagga Wagga, NSW
  13. Southern NSW Local Health District, Bega, NSW
  14. Prince of Wales Hospital/University of New South Wales, Randwick, New South Wales

Background: The NSW Statewide Telestroke (NSW TSS) service was established to improve access to acute stroke reperfusion therapies in regional NSW. Unique aspects of the service include standardised online screening, prospective data collection incorporated into clinical workflow and continuous Quality Improvement (QI) based on weekly state-wide multidisciplinary review.

Aims: Our primary aim was to evaluate the impact of the NSW TSS on reperfusion therapy frequency and speed of delivery.

Methods: Staggered service implementation began March 16, 2020, progressing from 2 to 23 regional primary stroke centres (10 of which previously did not offer acute stroke treatment) by June 15, 2022. Baseline clinical data, reperfusion therapy times and final diagnosis were prospectively collected and evaluated regularly. Treatment metrics were compared to data collected at 7 NSW TSS sites offering thrombolysis during the 3 years immediately prior to NSW TSS implementation.

Results: In the first 3 years of operation, 11840 patients with stroke symptoms were screened using the online Acute Stroke Assessment Protocol, resulting in 3388 telestroke consultations. A total of 2448 patients were diagnosed with an acute cerebrovascular syndrome (1900 ischaemic stroke, 291 intracranial haemorrhage, 257 Transient Ischaemic Attack), 698 of whom received reperfusion therapy (thrombolysis n=320, endovascular thrombectomy (EVT) n=168, EVT+thrombolysis n=206). The proportion of acute ischaemic stroke patients treated (698/1900, 36.7%) was significantly higher than that in the 3-year period prior to NSW TSS implementation (77/494, 15.6%, p<0.0001).

Median (IQR) Door-Needle-Time (DNT) for thrombolysis was 65 (26) minutes, which was significantly shorter than pre-implementation (95 (38) minutes; p<0.0001). Median (IQR) DNT ranged from 67 (28) in year 1 to 63 (27) minutes in year 3 (p=0.291), when 96/220 (43.6%) of DNTs were <60 minutes. Symptomatic haemorrhagic transformation rates were 0.3% (spontaneous), 2.5% (alteplase), 4.8% (EVT) and 2.9% (EVT+thrombolysis).

Conclusion: Telestroke significantly increased the proportion of regional ischaemic stroke patients receiving reperfusion therapies and decreased time to treatment initiation.