Abstract Number: Esoc2026a1707 Transforming the Culture of Rural Stroke Care: A Telestroke Hub-and-Spoke Approach to Reduce Post Thrombolysis Transfers to Academic Centers

Abstract Background and aims Routine post-intravenous thrombolysis (IVT) transfer of acute ischemic stroke patients to comprehensive stroke centers strains rural healthcare systems. A regional telestroke network may enable stroke-ready community hospitals to act as hubs for post-IVT monitoring of patients from smaller critical access facilities. Methods This retrospective cohort study evaluated transfer patterns before and after implementing a tiered retention protocol in a West Virginia telestroke network. Interventions included hub designation of community hospitals, evidence-based retention criteria for low-risk patients, staff education with 24/7 telestroke support, standardized monitoring, and explicit transfer triggers. Primary outcome was reduction in transfers to the comprehensive stroke center. Secondary outcomes were symptomatic intracranial hemorrhage (sICH) and in-hospital mortality. Results Annual transfers to the comprehensive stroke center averaged 143. 7 during the pre-intervention period (144 in 2022, 148 in 2023, 139 in 2024). Post-implementation, transfers decreased to 62 in 2025, representing a 56. 8% reduction. Over the four-year study period (2022-2025), 297 patients received IVT and remained at community hospitals. Among retained patients, sICH occurred in 1/297 (0. 34%), and in-hospital mortality was 1/297 (0. 34%). Estimated direct cost savings were 3, 000 per averted transfer, primarily from reduced air ambulance utilization. Additionally, an estimated 15, 000 in revenue per retained patient remained within community hospitals, supporting local stroke program development and sustainability. Conclusions This regional hub-and-spoke model enabled selective retention of low-risk post-IVT patients, achieving a 57% reduction in transfers while maintaining exceptional safety outcomes. This approach kept care closer to home for rural patients, optimized limited resources, and is readily replicable in other rural systems. Conflict of interest None of the authors have anything to disclose.