What Drives Greater Assimilation of Telestroke in Emergency Departments?

Published in: Journal of Stroke and Cerebrovascular Diseases, Volume 29, Issue 12 (December 2020). doi: 10.1016/j.jstrokecerebrovasdis.2020.105310

Posted on RAND.org on February 10, 2021

by Lori Uscher-Pines, Jessica L. Sousa, Kori Zachrison, Amy Guzik, Lee H. Schwamm, Ateev Mehrotra

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Objective

Although many emergency departments (EDs) have telestroke capacity, it is unclear why some EDs consistently use telestroke and others do not. We compared the characteristics and practices of EDs with robust and low assimilation of telestroke.

Methods

We conducted semi-structured interviews with representatives of EDs that received telestroke services from 10 different networks and had used telestroke for a minimum of two years. We used maximum diversity sampling to select EDs for inclusion and applied a positive deviance approach, comparing programs with robust and low assimilation. Data collection was informed by the Consolidated Framework for Implementation Research. For the qualitative analysis, we created site summaries and conducted a supplemental matrix analysis to identify themes.

Results

Representatives from 21 EDs with telestroke, including 11 with robust assimilation and 10 with low assimilation, participated. In EDs with robust assimilation, telestroke workflow was highly protocolized, programs had the support of leadership, telestroke use and outcomes were measured, and individual providers received feedback about their telestroke use. In EDs with low assimilation, telestroke was perceived to increase complexity, and ED physicians felt telestroke did not add value or had little value beyond a telephone consult. EDs with robust assimilation identified four sets of strategies to improve assimilation: strengthening relationships between stroke experts and ED providers, improving and standardizing processes, addressing resistant providers, and expanding the goals and role of the program.

Conclusion

Greater assimilation of telestroke is observed in EDs with standardized workflow, leadership support, ongoing evaluation and quality improvement efforts, and mechanisms to address resistant providers.

Research conducted by

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