Targeting telestroke: Benchmarking time performance in telestroke consultations

Objective: To describe the length of time physicians spend completing telestroke consultations and examine factors associated with that period. Methods: This is a retrospective review of data from telestroke software. Clinical data obtained between July 2010 and February 2011 from 8 hub and 24 spoke hospitals were abstracted for 235 consecutive consultations and linked to time metadata generated by software interaction. Consult length was defined as the time logged on to the robot and was exclusive of any telephone interaction or documentation time. Response time was defined as patient arrival to physician log-on. Results: Mean consult length for 203 complete, time-stamped cases was 14.5 minutes. There was no independent association between consult length and age, diagnosis, time of arrival from symptom onset, neurological exam findings, known recombinant tissue plasminogen activator (r-tPA) contraindications, and absence of vascular risk factors. Mean consult length was statistically longer in r-tPA-recommended cases (20.0 versus 15.3 minutes; P =.04). Mean response time was 76.3 minutes. Conclusions: The relatively short consult length suggests a workflow model in which acute stroke care is largely completed before telestroke consultation with a specialist rendering an expert opinion on previously gathered data performed off-line. The findings for prolonged response times indicate an area for improvement. Future workflow models for telestroke consultation will need to be reconsidered to optimize quality of care and clinical efficiency.