London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 675 620 Acute stroke: emergency management, stroke units and complications Comparing thrombolysis delivery during working hours and out-of-hours via telemedicine. N.R. Evans1, T.B. Stoker2, P.A. Phillips3 The Ipswich Hospital NHS Trust, Ipswich, UNITED KINGDOM1, The Ipswich Hospital NHS Trust, Ipswich, UNITED KINGDOM2, The Ipswich Hospital NHS Trust, Ipswich, UNITED KING-DOM3 Background: Intravenous thrombolysis is a mainstream treatment for acute ischaemic stroke. It is vital to admin-ister as soon as possible after symptom onset. Whilst it is impractical for every centre to have an on-site specialist to provide assessment for thrombolysis out-of-hours, telemedicine allows a single on-call stroke physician to deliver out-of-hour assessments across a broad geographical area. This study compares the timings in the delivery of thrombolysis during working hours and out-of-hours using telemedicine. Methods: This retrospective cohort study measured arrival-to-CT and CT-to-thrombolysis bolus times at Ips-wich Hospital from August 2007 to August 2012. Timings were taken from the Safe Implementation of Treatments in Stroke (SITS) database. Results: 119 individuals were thrombolysed (44 in-hours, 75 out-of-hours). 8 were excluded due to errors in recorded data. 42 (37.8%) were thrombolysed during working hours and 69 (62.2%) were thrombo-lysed out-of-hours. Mean arrival-to-CT interval was 30.3 (SD 16.7) minutes in-hours and 29.9 (SD 20) minutes out-of-hours (p=0.65). Mean CT-to-bolus time was 29 (SD 12.5) minutes in-hours and 60.1 (SD 32.4) minutes out-of-hours (p=2.22x10-8). Conclusion: This study illustrates the difficulty faced in out-of-hours acute stroke care. Significantly longer CT-to- bolus times out-of-hours reflect extra logistical difficulties with telemedicine that are not expe-rienced with in-hours face-to-face thrombolysis, including delays in establishing the telemedicine link, duration of the telemedicine consultation, inexperience and a frequent failure to recognise the urgency of thrombolysis. Compared to previous studies, this data shows no significant difference between the arrival-to-CT times, reflecting measures taken to minimise delays encountered out-of-hours. This study suggests strategies to expedite thrombolysis delivery, such as pre-prepared throm-bolysis packs, pre-alerts to radiology and on-call consultants, and staff education.
Karger_ESC London_2013
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