Kaiser telestroke program reduces 'door-to-needle' time by 20 minutes

The telestroke program implemented by Kaiser Permanente Northern California has shown an ability to reduce stroke patients' “door-to-needle” (DTN) time by 19.5 minutes, according to a study published in Stroke.

Reducing the time between when a patient has an acute ischemic stroke to when they receive treatment through intravenous alteplase is crucial in improving better outcomes. In 2015, Kaiser Permanente Northern California redesigned their EXpediting the PRocess of Evaluating and Stopping Stroke (EXPRESS) program to follow a standardized Helsinki model and have all stroke cases managed by a telestroke neurologist. In this study, researchers examined the effect of the telestroke program on DTN time and alteplase use.

The study collected data in nine-month periods before and after implementation of the telestroke program to compare DTN time and alteplase use. Overall, 310 patients were treated with alteplase before implementation of the telestroke program and 557 patients were treated after.

Results showed alteplase administrations increased from 34 per month to 62, while medical DTN time decreased from 53.5 minutes to 34 minutes, a difference of 19.5 minutes. Additionally, DTN time of less than one hour increased from 61 percent of the time to 87.1 percent. DTN times of less than 30 minutes were also improved by the telestroke program with 40.8 percent of cases compared to 4.2 percent before implementation.

“Introduction of a standardized modified Helsinki protocol across 21 hospitals using telestroke management was associated with increased alteplase administrations, significantly shorter DTN times, and no increase in adverse outcomes,” concluded first author Mai N. Nguyen-Huynh with the division of research at Kaiser Permanente Northern California.