Clinical Services

ePoster Presentation

(EP-110) Door to Page to Initiate a Telemedicine Consult Varies Among Spoke Hospitals for Acute Stroke

Sunday, April 23
4:35 PM - 4:50 PM
Location: Experience Zone - ePosters

Objectives
• Define the role of telestroke in increasing utilization of tissue plasminogen activator for acute ischemic stroke, and recognize potential delays in treatment time over telemedicine.
• Identify predictors for longer time to treatment with tissue plasminogen activator; specifically delays in the time between when an acute ischemic patient arrives to the spoke emergency room and when a telestroke consult is paged (door-to-page time).


Methods
We investigated spoke characteristics associated with the time between when an acute ischemic stroke patient arrives to the emergency room and when a telemedicine code stroke is paged. From 9/2015 to 3/2016, we identified suspected acute ischemic stroke patients in our telestroke registry who were evaluated remotely by video consultation at one of 15 spoke hospitals within six hours of symptom onset. We compared door-to-page-time among spokes, and identified factors associated with prolonged door-to-page-time.

Results
Median DTPT was 22 minutes (interquartile range 12 to 38). Of 382 cases 44.0% had door-to-page-time ≤ 20 minutes and 13.5% >60 minutes. There was no significant difference in door-to-page-time among patients of different age, gender, race/ethnicity, and stroke severity. Hospitals with fewer beds, no pre-notification protocols, location in a medically underserved area, and less in-house neurology availability had delayed door-to-page-time (p=0.007, 0.003, 0.017, and 0.038, respectively). Hospitals with ≤10 telestroke consultations per month had comparable door-to-page-time to those with >10 (p=0.938). Also, hospital with < 3 years in the telestroke network had comparable door-to-page-time to those with ≥3 (p=0.167).

Conclusion
Bed capacity, pre-notification, location in a medically underserved area, and in-house neurology availability are associated with prolonged door-to-page-time, however frequency of telestroke consultation and length of time in a telestroke network are not. While retrospective in nature, our study confirms the utility of pre-notification protocols for spoke hospitals. Further investigation is needed to understand why smaller hospitals and spokes in a medically underserved area have longer door-to-page-time, and how in-house neurology coverage affects door-to-page-time. In addition, standardized acute stroke metrics over telemedicine are needed.

Amanda L. Jagolino-Cole

Assistant Professor
University of Texas Health Science Center at Houston, McGovern Medical School

Dr. Amanda Jagolino-Cole majored in Biochemistry at the University of Pennsylvania, then taught English and health education in the Peace Corps in Ukraine. She graduated from Jefferson Medical College in Philadelphia. She trained in Neurology at the University of Miami/Jackson Memorial Hospital, where she served as Chief Resident. She first became interested in expanding emergency stroke care to underserved populations while completing Vascular Neurology fellowship at the University of Texas Medical School at Houston. There, as Assistant Professor of Neurology, her research focuses on characterizing and improving the role of telemedicine in providing advanced acute stroke care to other communities.

Presentation(s):

Send Email for Amanda Jagolino-Cole

Shima Bozorgui

Research Assistant II
The University of Texas Health Science Center at Houston

Dr. Shima Bozorgui is a Research Assistant II in the Department of Neurology at The University of Texas Health Science Center at Houston, McGovern Medical School. She got her MD degree from Tehran University of Medical Sciences (TUMS) and after graduation she practiced as a physician for two years. She worked as a medical officer and the head of a medical team in an urban public health center in an underserved area. She also holds MPH degree in Epidemiology from The University of Texas Health Science Center at Houston. She worked as a research volunteer at Baylor St. Luke's Medical Center, Department of Internal Medicine mainly on two prospective observational studies on Clostridium Difficile Associated Diarrhea (CDAD). Currently she is collaborating in preparing the Lone Star Stroke Consortium TeleStroke Registry (LESTER) via collecting data on all telemedicine treated stroke patients throughout the Texas Lone Star network.

Presentation(s):

Send Email for Shima Bozorgui

Arvind Bambhroliya

Sr Research Assistant
University of Texas Health Science Center at Houston

Dr. Arvind Bambhroliya is a Senior Research Assistant in the Department of Neurology at The University of Texas Health Science Center at Houston. He holds an MBBS degree from The Maharaja Sayajirao University of Baroda, an MPH and MS degree from The University of Texas Health Science Center at Houston. He has over 5 years of research experience working on multiple epidemiological and biomedical research projects and is a recipient of the M. D. Anderson Alumni and Faculty Association Graduate Student Award in Population/Patient-Oriented Research (first place). He is extremely interested in learning and applying everything that matters in bringing science from the bench to the clinic.

Presentation(s):

Send Email for Arvind Bambhroliya

Farhaan Vahidy

Assistant Professor
The University of Texas Health Science Center at Houston, McGovern Medical School

Dr. Farhaan Vahidy graduated medical school in 1996 and did a general medicine and emergency medicine residency. For about 12 years he practiced emergency medicine and field medicine as a military physician. He also trained and worked as a flight surgeon with the Air Force. Later he completed my Masters in Public Health, following which he taught courses in epidemiology and biostatistics to MPH and BSN students. His earlier research was in epidemiology of non-communicable diseases like depression and cardio-vascular diseases in developing countries. He completed his doctoral research degree (PhD) from University of Texas School of Public Health in epidemiology and biostatistics. His research interests are epidemiology and primary and secondary prevention of stroke, stroke recovery, and health systems research for stroke care delivery.

Presentation(s):

Send Email for Farhaan Vahidy

TC Cossey

Assistant Professor of Neurology
University of Texas Health Science Center

Dr. TC Cossey majored in Biological Anthropology and Anatomy at Duke University, then graduated from the University of Alabama at Birmingham School of Medicine. She trained in Neurology at Barrow Neurological Institute in Phoenix, Arizona, where she served as Chief Resident. Dr. Cossey completed a Vascular Neurology fellowship at the University of Texas at Houston, and joined faculty as Assistant Professor of Neurology. Her research interests include optimizing treatments of acute stroke, and using telemedicine to improve access to stroke care for underserved populations.

Presentation(s):

Send Email for TC Cossey

Alyssa D. Trevino

Research Coordinator
UTHealth

Alyssa Trevino is a Research Coordinator in the Department of Neurology at The McGovern Medical School. She holds a Bachelor’s degree from St. Mary’s University, majoring in Biology, and has over 2 years of clinical research experience in Phase 1 clinical trials. Alyssa is extremely passionate working in clinical research and continues to seek new beneficial and feasible ways to assist patients living a healthy, productive life.

Presentation(s):

Send Email for Alyssa Trevino

Sean I. Savitz

Frank M. Yatsu Chair and Professor of Neurology
The University of Texas Health Science Center at Houston, McGovern Medical School

Sean I. Savitz, MD is a tenured Professor of Neurology, holds the Frank M. Yatsu Chair in Neurology, and directs the Stroke Program at the University of Texas Medical School in Houston. He graduated from Harvard College, received his MD from Albert Einstein College of Medicine, and completed neurology residency training and a cerebrovascular fellowship at the Harvard Medical School Neurology Training Program. He and his team run one of the largest academic stroke programs in the world, testing novel treatments for patients with ischemic stroke and brain hemorrhage. Dr. Savitz oversees a bidirectional, translational laboratory and clinical research program on cell therapies in stroke and is conducting some of the first clinical trials testing cell therapies in stroke patients.

Presentation(s):

Send Email for Sean Savitz

Tzu-Ching Wu

Assistant Professor of Neurology
UTHealth -- The University of Texas Health Science Center at Houston

Dr Teddy Wu received his medical degree from the University of Maryland in Baltimore, MD. From there, he did his neurology residency at Barrow Neurological Institute in Phoenix, AZ, and completed a two-year vascular neurology fellowship with the University of Texas Medical School at Houston world-renown stroke team. His research and clinical interests focus on development of new technologies that will enhance delivery of acute stroke care. As the director of the Mischer Neuroscience Institute Telemedicine Network, he directs and participates in the team that provides over 1300 acute neurological consultations per year, including over 200 IV-t-PA treated patients annually. He is also heavily interested in utilizing mobile technology and will be recently conducted a pilot trial using mobile telemedicine in ambulance to help accurately triage patients with acute stroke.

Presentation(s):

Send Email for Tzu-Ching Wu

Christy M. Ankrom

Program Manager, Research Manager
University of Texas Health Science Center at Houston, McGovern Medical School

Christy Ankrom has been with The University of Texas Health Science Center at Houston (UTHSCH) Department of Neurology since 2002. She earned a Bachelor of Science degree from the University of Houston – Clear Lake. She is the program manager of the UTHSCH regional teleneurology network, and the research manager of the Houston hub of the Lone Star Stroke Research Consortium, funded by the Texas Department of State Health Services.

Presentation(s):

Send Email for Christy Ankrom


Assets

(EP-110) Door to Page to Initiate a Telemedicine Consult Varies Among Spoke Hospitals for Acute Stroke



Attendees who have favorited this

Send Email for Door to Page to Initiate a Telemedicine Consult Varies Among Spoke Hospitals for Acute Stroke