Telestroke for Comprehensive Stroke Care in Acute Stroke Ready Hospitals

Telestroke is a validated intervention that improves the triage and emergent treatment of
acute stroke, specifically related to the use of intravenous thrombolysis. Effective urgent
stroke evaluation and secondary stroke prevention is also essential to decrease the risk of
recurrent stroke, however, there have been no studies to date examining the use of telestroke
to improve delivery of non-emergent inpatient stroke care per American Heart Association
(AHA) guidelines.

Currently, access to stroke specialist expertise is limited resulting in significant
disparities in stroke care. Previous publications have identified that patients in rural
areas may receive sub-optimal stroke care that does not follow accepted guideline
recommendations. Telestroke is a cost-effective mechanism to deliver specialist stroke care
to hospitals that do not have in-person stroke consultation available. The aim of TELECAST is
to determine whether specialist telestroke inpatient rounding improves guideline-based acute
stroke care when compared to non-specialist stroke care.

The primary outcome of TELECAST is a composite score comprising 4 categories: diagnostic
stroke evaluation, secondary stroke prevention, health screening and evaluation, and stroke
education. Individual components of the primary outcome were primarily derived from AHA
stroke guidelines. Additional outcome measures include individual analyses of the components
of the primary outcome as well as the complication rate, stroke recurrence rate, transfer
rate, patient and provider satisfaction levels, and a cost-analysis. All outcomes will be
assessed at 1 year post-implementation, with data accruement beginning after a 3-month lead
in phase.

Inclusion Criteria:

- Age 18 and above

- Patients with the primary diagnosis of ischemic stroke admitted to Fairview Ridges
Hospital

- Evidence of stroke on MRI or CT or clinical diagnosis of acute ischemic stroke by the
treating stroke service

Exclusion Criteria:

- Patients less than 18 years old

- Patients who leave the hospital against medical advice

- Patients with goals of care that impact the stroke evaluation (i.e. comfort measures)

- Patients who are felt to have an alternative diagnosis

- Patients who are transferred for higher-level stroke care such as endovascular
thrombectomy or decompressive craniectomy