Using telemedicine eliminates the weekend/after-hours effect in acute ischemic stroke patients receiving thrombolysis during a deadly pandemic

ABSTRACT

Stroke care has been shown to be worse for patients presenting overnight/weekends (off-hours) to centers compare to those presenting during business hours (on-hours).Telemedicine (TM) helps provide safe management of stroke patients. The UT Teleneurology (UTT) hub provides acute neurological coverage by stroke specialists to 18 spoke centers. To our knowledge, the effect of the Covid-19 pandemic on the “weekend effect” has not been studied. The objective is to compare TM consult volumes and time metrics of stroke patients who received tPA via TM off-hours with those on-hours during the pandemic. In a retrospective query of the UTT registry from 3/20 - 6/20, we identified 122 stroke patients who received tPA - 109 were included in our analysis - 2 were excluded after quality check, 11 were excluded as inpatient strokes. We compared baseline characteristics and time metrics between the off-hours (5pm-759am, weekends) and on-hours (weekdays 8am-459pm) patients (Table 1). We also compared the number of TM consults between the height of the pandemic (3/20 - 6/20) and the previous year (3/19 - 6/19). Of 109 patients, 72 were managed via TM during off-hours, 37 during on-hours. Baseline characteristics were similar between groups. There were no differences in time metrics including door to needle time. Of note, there was no difference in the number of acute TM consults or patients receiving tPA. There were fewer routine TM consults during the pandemic, and a trend toward fewer phone consults. There was no difference in time metrics between the patients treated off-hours vs on-hours in the pandemic period. TM may be advantageous over in-person neurology coverage during crises, and is consistent regardless of the hour/day. Contrary to other studies, the number of acute TM consults and patients receiving tPA did not differ between the study periods. Routine consults decreased during the pandemic - perhaps coinciding with state closure mandates/fewer hospitalized stroke patients. (Figure Presented).