Acute stroke timing measures such as door-to-call time and door-to-decision time have not improved with the development of the telestroke network in northern NSW.
A comparison of metrics between phase 1 (Jan 2017 – Oct 2018) and phase 2 (Nov 2018 – July 2019) of the network expansion suggested the main limiting factors may be workforce shortages and high staff turnover.
The study, published in Frontiers in Neurology, found 73% of the 827 patients assessed with multimodal computed tomography (mCT) had ischemic stroke or TIA.
Overall, the median door-to-call time was 36 min, the median door-to-image was 50 min, and the median door-to-decision was 82 min.
“There was no significant difference between phases for these metrics. Phase 1 had a median door-to-call of 39 min compared to 35 min in phase 2 (p = 0.18), median door-to-image was 49 min in phase 1 and 54 min in phase 2 (p = 0.36) and median door-to-decision was 81.5 min in phase 1 and 83 min in phase 2 (p = 0.31),” the study said.
In the subgroup of patients who received reperfusion therapy, there was a significant decrease in the rate of thrombolysis in phase 2 compared to phase 1 (76.5 vs. 53.7%, p = 0.01) but an increase in use of EVT (45.6 vs. 65.9%, p = 0.04).
There was a non-significant trend to slighter shorter door-to-call, door-to-image and door-to-decision times in this sub-group in phase 2 compared to phase 1.
In the thrombolysed subgroup, door-to-needle time was also slightly shorter in phase 2 than phase 1 but did not reach statistical significance.