Less Experienced Telestroke Consultants Are More Likely to Go On-Camera, but Less Likely to Give tPA

Abstract

Background Stroke telemedicine (telestroke) increases tPA availability and administration. However, the effective use of telestroke requires training, which is not a standard component of vascular neurology training. As a result, many providers learn telestroke skills “on the job” after finishing their training. Aims We sought to explore if providers with more telestroke experience would be more efficient in the utilization of telemedicine, compared to providers with less experience. Methods We prospectively collected data on telestrokes between July 2014 and July 2017 at a Comprehensive Stroke Center. Telestrokes are initiated on the telephone and typically, but not always, followed by an on-camera consult. Decision to do a phone-only versus on-camera consult is at the provider's discretion. Results There were 1,029 telestrokes, of which 807 were on-camera (74%). Of the 8 telestroke providers, 4 had less experience, having just finished stroke fellowship, and 4 had more experience (mean = 7.8 years of telestroke experience at the beginning of the study). Providers with less experience were more likely to go on camera than providers with more experience (79% vs. 67% of consults, p = 0.021), but were less likely to give tPA when on-camera (25% vs. 33%, p = 0.023). The absolute rate of tPA administration, combining phone and camera administration, or the frequency of technical difficulties were not different. Conclusions Telestroke consultants with less experience do not triage as many cases by phone and are less likely to administer tPA on-camera, suggesting their use of telemedicine is not optimized. This supports the introduction of telestroke didactics during vascular neurology training.

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“…The AAN recognized the need to incorporate telemedicine in neurology training in 2013 and multiple subsequent publications outline recommended curricula, 1,5,6,9 provide data on implemented programs, 7,9,10 and demonstrate the real-world benefits of systematic telemedicine training. [7][8][9] Anecdotally, the residents at our 3 institutions have expressed increasing interest and curiosity regarding additional teleneurology exposure, which is magnified by the emergent changes in clinical practice implemented in response to the COVID-19 pandemic. The lack of mandated education in this area has led to slow adoption of training in teleneurology.…”

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“…This paper also builds on a 2012 review, 20 which found that relationships (e.g., between hubs and their spoke sites) matter more than technology sophistication, by showing one kind of relationship that works well. To address a known lack of formal training for acute telestroke, 45…”

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“…This paper also builds on a 2012 review, 21 which found that relationships (e.g., between hubs and their spoke sites) matter more than technology sophistication, by showing one kind of relationship that works well. To address a known lack of formal training for acute telestroke, 48 Last, our study adds to research on physicians' increasing use of secure, consumer-oriented mobile messaging software like WhatsApp. 49,50 In our study, mobile messaging was associated with team cohesion by fostering participant satisfaction and ease of communication.…”

“…This paper also builds on a 2012 review, 21 which found that relationships (e.g., between hubs and their spoke sites) matter more than technology sophistication, by showing one kind of relationship that works well. To address a known lack of formal training for acute telestroke, 48 our study shows how NTSP's weekly calls, discussions of the latest evidence, and open communication between peers and program administrators link specialists in different career stages for on-the-job training.…”