VA hospital telestroke networks improve treatment, lower ED transfer rate

Telestroke networks improve acute stroke treatment for veterans and positively affect the efficiency of interhospital networks by avoiding unnecessary ED transfers, according to a study published in Neurology.

“Interhospital transfer for stroke has increased over the past two decades, particularly with the expansion of eligibility for endovascular thrombectomy,” Michael J. Lyerly, MD, associate professor of neurology at the University of Alabama at Birmingham, and colleagues wrote. “This has the potential to overburden tertiary centers with stroke mimics or thrombectomy-ineligible patients, as well as to increase health care expenditures.”

Researchers sought to examine the impact and effectiveness of the VA National Telestroke Program on hospital transfers among U.S. military veterans diagnosed with acute ischemic stroke (AIS).

The study analyzed 3,488 stroke encounters from 3,289 patients across 21 VA hospitals before (n = 1,056) and after (n = 2,432) implementation of the program. Researchers assessed transfer rates through administrative data and chart review and documented patient and facility-level characteristics to identify potential transfer predictors.

According to study results, there was an absolute 14.4% decrease in transfers across all levels of stroke center designation following program implementation. Reasons for transfer included younger age, higher stroke severity and shorter duration from symptom onset. Researchers also found that only hospitals with lower annual stroke volume were more likely to transfer AIS patients, with just one hospital experiencing an increase in transfer rate after program implementation.

Further, implementation of the program resulted in a nearly 60% reduction in transfer odds, after adjusting for patient and facility characteristics (OR, 0.39; 0.19-0.77).

“Our analysis suggests that, within a national health care system, in addition to improving stroke treatment rates, a potential decrease in unnecessary ED transfers may be another way that telestroke improves the quality and efficiency of stroke systems of care,” Lyerly and colleagues wrote.