Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort

Abstract

Introduction Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (a) identify the impact of telemedicine on emergency department (ED) stroke care, (b) identify if telemedicine impact varied by network and (c) describe the variation in process outcomes by telemedicine across EDs. Methods A prospective cohort study identified stroke patients in four telemedicine networks between November 2015 and December 2017. Primary exposure was telemedicine consultation during ED evaluation. Outcomes included: (a) interpretation of computed tomography (CT) of the head within 45 minutes and (b) time to administer tissue plasminogen activator (tPA). An interaction term tested for differences in telemedicine effect on stroke care by network and hospital. Results Of the 932 stroke subjects, 36% received telemedicine consults. For subjects with a last known well time within two hours of ED arrival (27.9%), recommended CT interpretation within 45 minutes was met for 66.8%. Telemedicine was associated with higher odds of timely head CT interpretation (adjusted odds ratio = 3.03; 95% confidence interval (CI) 1.69–5.46). The magnitude of the association between telemedicine and time to interpret a CT of the head differed between telemedicine networks (interaction term p = 0.033). Among eligible patients, telemedicine was associated with faster time to administer tPA (adjusted hazard ratio = 1.81; 95% CI 1.31–2.50). Discussion Telemedicine consultation during the ED encounter decreased the time to interpret at CT of the head among stroke patients, with differing magnitudes of benefit across telemedicine networks. The effect of heterogeneity of telestroke affects across different networks should be explored in future analyses.

Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper From the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (Part 2)

“…This somewhat relieves concerns about impaired patient–physician connection through telemedicine. While telemedicine decreases the time it takes to analyze head CTs, more work is needed to ensure that this benefit applies equally across different telestroke programs ( 30 ).…”

HRSA’s evidence-based tele-emergency network grant program: Multi-site prospective cohort analysis across six rural emergency department telemedicine networks

“…Very few analyses of telehealth interventions have pooled data from multiple networks, and a systematic review of teleED implementation papers did not identify any multi-network studies [12]. The goal of the EB TNGP program was to pool heterogeneous networks that have expanded to scale to better estimate how teleED might reshape rural health care if it were expanded beyond the networks that pioneered its use [32][33][34][35]. Observing the variation between networks in their application and use increases confidence in how teleED might perform at scale, and it allows for better prediction of the impact of systematic telehealth expansion into new health systems.…”