The Role of Videoconferencing Teleconsultation in Improving Transfer Efficiency and Functional Outcomes in Rural Stroke Care: Retrospective Cohort Study.

Background: Interhospital transfer delays remain a major barrier to timely reperfusion therapy and are associated with worse functional outcomes in acute ischemic stroke (AIS), particularly in rural regions. Objective: This study evaluated whether videoconferencing teleconsultation, compared with the standard referral process, was associated with improved transfer efficiency, treatment delivery, and functional outcomes for patients with AIS requiring interhospital transfer in a hub-and-spoke model. Methods: We conducted a retrospective cohort study of patients with AIS identified as potential candidates for endovascular thrombectomy (EVT) who were transferred from a primary stroke center (PSC) to a comprehensive stroke center (CSC) between January 2022 and December 2024. Patients were managed using either videoconferencing teleconsultation or the standard referral process, defined as telephone-based consultation between emergency physicians at the PSC and CSC, in which clinical evaluation and thrombolysis decisions were made primarily by the PSC emergency physicians. Group allocation was determined via institutional workflow. The primary outcome was door-in-door-out time, with additional analyses on its components. Secondary outcomes included intravenous thrombolysis rate at the PSC, EVT rates at the CSC, door-to-puncture time, reperfusion rates, and 90-day functional outcomes assessed via modified Rankin Scale shift analysis. Safety outcomes included all-cause mortality within 90 days and symptomatic intracranial hemorrhage after intravenous thrombolysis and/or EVT. Results: A total of 83 patients were included, with 41 (49.4%) in the teleconsultation group and 42 (50.6%) in the standard referral process group (mean age 73.3, SD 12.9 years), and baseline characteristics were comparable. Teleconsultation was associated with a significant reduction in door-in-door-out time (mean 95.2, SD 22.9 vs 132.3, SD 41.5 minutes; P<.001) by shortening computed tomography angiography-to-ambulance notification time (mean 44.6, SD 17.4 vs 79.5, SD 37.6 minutes; P<.001). The teleconsultation group had higher intravenous thrombolysis rates at the PSC (26/41, 63.4% in the teleconsultation group vs 17/42, 40.5% in the standard referral process group; P=.04), higher EVT rates (14/41, 34.1% in the teleconsultation group vs 6/42, 14.3% in the standard referral process group; P=.03), and shorter door-to-puncture time (mean 83.0, SD 35.5 vs 118.5, SD 25.9 minutes; P=.04) at the CSC. Patients who received teleconsultation demonstrated a greater shift toward better functional outcomes at the 90th day (27/41, 65.9%; odds ratio 4.55, 95% CI 1.96-11.11; P<.001) than patients who did not (13/42, 31.0%; odds ratio 1.35, 95% CI 0.63-2.94; P=.07). Safety outcomes were comparable between groups. Conclusions: Videoconferencing teleconsultation was associated with improved transfer efficiency and higher use of reperfusion therapies and was potentially associated with better functional outcomes. This model may represent a feasible strategy for optimizing stroke care pathways in rural settings. Future studies are warranted to assess its applicability in broader stroke populations beyond conventional EVT eligibility criteria across multicenter networks.