JMIR Publications

ABSTRACT

Background:

Telestroke has had widespread adoption, enabling many hospitals to obtain stroke center certification. Pediatric telehealth has been less-widely adopted. We hypothesized that differences in financial incentives (based on differences in patient volume, prehospital routing policy, and certification requirements) contributed to differential ED adoption.

Objective:

Our primary objective was to determine whether differences in policy or certification requirements contributed to differential uptake of telestroke versus pediatric telehealth.

Methods:

We used the 2016 National ED Inventory (NEDI)-USA to identify EDs using telestroke and pediatric telehealth. We surveyed all EDs using pediatric telehealth (n=339) and a convenience sample of the 1,758 telestroke EDs (n=366). The surveys characterized ED staffing, transfer patterns, reasons for adoption, and frequency of use. We used bivariate comparisons to examine differences in reasons for adoption and use between EDs using only telestroke, only pediatric telehealth, or both.

Results:

Of 442 EDs surveyed, 378 (86%) indicated receipt of telestroke, pediatric telehealth, or both. EDs with both were smaller in bed size, volume, and ED attending coverage than those with only telestroke or only pediatric telehealth. Telestroke-using EDs reported more frequent use overall than EDs with pediatric telehealth; the majority of EDs with pediatric telehealth reported 0-12 telehealth consults in the past year. The most frequently selected reason for adoption was “improving level of clinical care.” Policy-related reasons were rarely indicated as the most important (telestroke: 4%, pediatric telehealth: 0.4%).

Conclusions:

In 2016, more US EDs had telestroke than pediatric telehealth; among EDs with the technology, consults were more frequently made for stroke than pediatric patients. The most frequently indicated reason for adoption among all EDs was related to clinical care. Clinical Trial: n/a