The aim was to determine whether cerebrovascular trained APRNs covering our 24/7/365 CSC telestroke service could accurately and safely administer alteplase as well as our neurology physician colleagues.

Acute Ischemic Stroke (AIS) treatment is time sensitive.  Many hospitals lack neurology expertise to assess patients and assist emergency medicine colleagues with administration of thrombolytic therapy.  Telestroke services have been shown to be as safe for administering thrombolytic therapy as on-site neurological expertise.  Neurologists covering acute stroke services on-site and via telemedicine are in short supply.  Advance Practice Registered Nurses (APRNs) specializing in stroke and cerebrovascular disease have helped fill the gap, however, data are lacking on APRN acute telestroke coverage, thrombolytic administration, and patient outcomes.

All consecutive AIS telestroke consults were reviewed at 5 rural community hospital spoke sites from 1/1/17-5/31/20.  Telestroke call was shared among 3 vascular neurologists and 2 APRNs.  Both APRNs have > 10 years of cerebrovascular disease experience.  Nationally accepted AHA guidelines for inclusion/exclusion for alteplase administration were followed and documented accordingly up to 4.5 hours from onset.

A total of 2,389 telestroke consults were performed (775 MD, 1,614 APRN).  Of those, 150 were diagnosed with suspected AIS, met criteria for alteplase, and it was administered.  There were no statistical differences between care provided by physicians compared to APRNs regarding patient demographics, initial NIHSS, Door to needle times, final diagnosis, symptomatic hemorrhage, or discharge disposition. 

Our data shows that APRNs at our CSC providing telestroke coverage at 5 rural community hospitals resulted in no statistical difference in stroke care delivery and patient outcomes compared to our physician colleagues. Incorporating APRNs into telestroke call coverage needs further study to better define necessary telehealth training, curriculum, standardized professional competencies, and consideration of state laws.