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Thilemann S, Traenka CK, Schaub F, Nussbaum L, Bonati L, Peters N, Fladt J, Nickel C, Hunziker P, Luethy M, Schädelin S, Ernst A, Engelter S, De Marchis GM, Lyrer P. Real-time video analysis allows the identification of large vessel occlusion in patients with suspected stroke: feasibility trial of a "telestroke" pathway in Northwestern Switzerland. Front Neurol 2023; 14:1232401. [PMID: 37941577 PMCID: PMC10627858 DOI: 10.3389/fneur.2023.1232401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/12/2023] [Indexed: 11/10/2023] Open
Abstract
Background and aim Loss of time is a major obstacle to efficient stroke treatment. Our telestroke path intends to optimize prehospital triage using a video link connecting ambulance personnel and a stroke physician. The objectives were as follows: (1) To identify patients suffering a stroke and (2) in particular large vessel occlusion (LVO) strokes as candidates for endovascular treatment. We have chosen the Rapid Arterial Occlusion Evaluation (RACE) scale for this purpose. Methods This analysis aimed to verify the feasibility of prehospital stroke identification by video assessment. In this prospective telestroke cohort study, we included 97 subjects, in which the RACE score (items: facial palsy, arm and leg motor function, head and gaze deviation, and aphasia or agnosia) was applied, and the assessment videotaped by a trained member of the Emergency Medical Services (EMS) in the field using a mobile device. Each recorded patient video was independently assessed by three experienced stroke physicians from a certified stroke center and compared to the neuroimaging gold standard. Within this feasibility study, the stroke code was not altered by the outcome of the RACE assessment, and all patients underwent the standard procedures within the emergency unit. Results We analyzed 97 patients (median age 78 years, 53% women), of whom 51 (52.6%) suffered an acute stroke, 12 (23.5%) of which were due to an LVO and 46 patients had symptoms mimicking a stroke. The sensitivity of stroke identification was 77.8%, and specificity was 53.6%. In regard to the identification of an LVO, sensitivity was 69.4% and specificity was 84.3%. The inter-rater agreement in the RACE-score assessment was ICC = 0.82 (intraclass-correlation coefficient). Conclusion These results confirm our hypothesis that the local telestroke concept is feasible. It allows correct (i) stroke and (ii) LVO identification in the majority of the cases and thus has the potential to assist in efficient prehospital triage.
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Affiliation(s)
- Sebastian Thilemann
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kenan Traenka
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Fabian Schaub
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lukas Nussbaum
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Leo Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nils Peters
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Joachim Fladt
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Nickel
- Department of Emergency, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Hunziker
- Medical Intensive Care Units, University Hospital Basel, Basel, Switzerland
| | - Marc Luethy
- Anaesthesiology, University Hospital Basel, Switzerland and Emergency Medical Service (EMS) Basel, Basel, Switzerland
| | - Sabine Schädelin
- Clinical Trial Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Axel Ernst
- ICT Service and Support, University Hospital Basel, Basel, Switzerland
| | - Stefan Engelter
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital St Gallen, St. Gallen, Switzerland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
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Chuo J, Makkar A, Machut K, Zenge J, Jagarapu J, Azzuqa A, Savani RC. Telemedicine across the continuum of neonatal-perinatal care. Semin Fetal Neonatal Med 2022; 27:101398. [PMID: 36333212 PMCID: PMC9623499 DOI: 10.1016/j.siny.2022.101398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- John Chuo
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Abhishek Makkar
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center; Oklahoma City, Oklahoma, USA
| | - Kerri Machut
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jeanne Zenge
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital of Colorado, Aurora, CO, USA
| | - Jawahar Jagarapu
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abeer Azzuqa
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Rashmin C. Savani
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Zachrison KS, Hayden EM, Boggs KM, Boyle TP, Gao J, Samuels-Kalow ME, Marcin JP, Camargo CA. Emergency Departments' Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study. J Med Internet Res 2022; 24:e33981. [PMID: 35723927 PMCID: PMC9254043 DOI: 10.2196/33981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/25/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telehealth for emergency stroke care delivery (telestroke) has had widespread adoption, enabling many hospitals to obtain stroke center certification. Telehealth for pediatric emergency care has been less widely adopted. OBJECTIVE Our primary objective was to determine whether differences in policy or certification requirements contributed to differential uptake of telestroke versus pediatric telehealth. We hypothesized that differences in financial incentives, based on differences in patient volume, prehospital routing policy, and certification requirements, contributed to differential emergency department (ED) adoption of telestroke versus pediatric telehealth. METHODS We used the 2016 National Emergency Department Inventory-USA to identify EDs that were using telestroke and pediatric telehealth services. We surveyed all EDs using pediatric telehealth services (n=339) and a convenience sample of the 1758 EDs with telestroke services (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 with only telestroke services, only pediatric telehealth services, or both. RESULTS Of the 442 EDs surveyed, 378 (85.5%) indicated use of telestroke, pediatric telehealth, or both. EDs with both services were smaller in bed size, volume, and ED attending coverage than those with only telestroke services or only pediatric telehealth services. EDs with telestroke services reported more frequent use, overall, than EDs with pediatric telehealth services: 14.1% (45/320) of EDs with telestroke services reported weekly use versus 2.9% (8/272) of EDs with pediatric telehealth services (P<.001). In addition, 37 out of 272 (13.6%) EDs with pediatric telehealth services reported no consults in the past year. Across applications, the most frequently selected reason for adoption was "improving level of clinical care." Policy-related reasons (ie, for compliance with outside certification or standards or for improving ED performance on quality metrics) were rarely indicated as the most important, but these reasons were indicated slightly more often for telestroke adoption (12/320, 3.8%) than for pediatric telehealth adoption (1/272, 0.4%; P=.003). CONCLUSIONS In 2016, more US EDs had telestroke services than pediatric telehealth services; among EDs with the technology, consults were more frequently made for stroke than for pediatric patients. The most frequently indicated reason for adoption among all EDs was related to clinical care.
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Affiliation(s)
- Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Krislyn M Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Tehnaz P Boyle
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States
| | - Jingya Gao
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | | | - James P Marcin
- Department of Pediatrics, University of California Davis School of Medicine, University of California, Sacramento, CA, United States
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
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Zachrison KS, Richard JV, Wilcock A, Zubizaretta JR, Schwamm LH, Uscher-Pines L, Mehrotra A. Association of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks. JAMA Netw Open 2021; 4:e2126612. [PMID: 34554236 PMCID: PMC8461501 DOI: 10.1001/jamanetworkopen.2021.26612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE It has been proposed that the implementation of telestroke services (a web-based approach to using video telecommunication to treat patients with stroke before hospital admission) changes where patients with stroke symptoms receive care, but this proposal has not been rigorously assessed. OBJECTIVE To assess whether the implementation of telestroke services is associated with changes in where and how patients initially present with stroke symptoms, in their decision to be transferred to another hospital, and which hospitals they are transferred to. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study compared changes in stroke systems of care between a sample of 593 US hospitals that adopted telestroke during the period from 2009 to 2016 but were not comprehensive stroke centers, major teaching hospitals, or thrombectomy-capable hospitals vs 593 matched control hospitals without telestroke based on rural location, critical access hospital status, bed size, primary stroke center status, presence of hospital alternatives in the community, hospital stroke volume, census region, and ownership. With the use of data on 100% of Medicare fee-for-service beneficiaries, all stroke and transient ischemic attack admissions from 2008 to 2018 were identified. EXPOSURES For each hospital pair (telestroke plus matched control), the telestroke hospital's implementation date and difference-in-differences approach were used to quantify the association between telestroke implementation and changes in care from 2 years before implementation to 2 years after implementation. Models also controlled for differences in observed patient characteristics. MAIN OUTCOMES AND MEASURES Hospital stroke volume, patients' ambulance transport distance to initial hospital, hospital case mix, interhospital transfer proportion, and size of the receiving hospital for transferred patients. RESULTS Of the 669 telestroke hospitals and 2143 potential control hospitals, 593 hospital pairs were matched; in each category, 261 hospitals (44.0%) were located in a rural area, 179 (30.2%) were primary stroke centers, and 130 (21.9%) were critical access hospitals. The changes in the preimplementation to postimplementation period were similar at telestroke and control hospitals in mean annual stroke volume (telestroke hospitals, decreased from 79.6 to 76.3 patients; control hospitals, decreased from 78.8 to 75.5 patients [-3.3 patients per year for both; difference-in-differences, 0.009; P ≥ .99]). Similarly, no differences were seen in ambulance transport distance, case mix, interhospital transfers, or bed size of receiving hospitals among transferred patients. CONCLUSIONS AND RELEVANCE This study suggests that, across a national sample of hospitals implementing telestroke, no association between telestroke adoption and changes in stroke systems of care were found.
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Affiliation(s)
- Kori S. Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Jessica V. Richard
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Andrew Wilcock
- Department of Family Medicine, University of Vermont College of Medicine, Burlington
| | - Jose R. Zubizaretta
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston
| | | | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Zachrison KS, Boggs KM, Hayden EM, Cash RE, Espinola JA, Samuels‐Kalow ME, Sullivan AF, Mehrotra A, Camargo CA. Factors associated with emergency department adoption of telemedicine: 2014 to 2018. J Am Coll Emerg Physicians Open 2020; 1:1304-1311. [PMID: 33392537 PMCID: PMC7771831 DOI: 10.1002/emp2.12233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Telemedicine is used by emergency departments (EDs) to connect patients with specialty consultation and resources not available locally. Despite its utility, uptake of telemedicine in EDs has varied. We studied characteristics associated with telemedicine adoption during a 4-year period. METHODS We analyzed data from the 2014 National Emergency Department Inventory (NEDI)-New England survey and follow-up data from 2016 and 2017 NEDI-USA and 2018 NEDI-New England surveys, with data from the Center for Connected Health Policy. Among EDs not using telemedicine in 2014, we examined characteristics associated with adoption by 2018. RESULTS Of the 159 New England EDs with available data, 80 (50%) and 125 (79%) reported telemedicine receipt in 2014 and 2018, respectively. Among the 79 EDs without telemedicine in 2014, academic EDs were less likely to adopt by 2018 (odds ratio, 0.12; 95% confidence interval, 0.03-0.46). State policy environment was not associated with likelihood of adoption. In 2018, all 7 freestanding EDs received telemedicine, whereas only 1 of 9 academic EDs (11%) did. CONCLUSIONS Telemedicine use by EDs continues to grow rapidly and by 2018, >3 quarters of EDs in our sample were receiving telemedicine. From 2014 to 2018, the initiation of telemedicine receipt was less common among higher volume and academic EDs.
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Affiliation(s)
- Kori S. Zachrison
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Krislyn M. Boggs
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Emily M. Hayden
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Rebecca E. Cash
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Janice A. Espinola
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Margaret E. Samuels‐Kalow
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Ashley F. Sullivan
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Ateev Mehrotra
- Department of Healthcare PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Carlos A. Camargo
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
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Sharma R, Zachrison KS, Viswanathan A, Matiello M, Estrada J, Anderson CD, Etherton M, Silverman S, Rost NS, Feske SK, Schwamm LH. Trends in Telestroke Care Delivery: A 15-Year Experience of an Academic Hub and Its Network of Spokes. Circ Cardiovasc Qual Outcomes 2020; 13:e005903. [PMID: 32126805 PMCID: PMC7374496 DOI: 10.1161/circoutcomes.119.005903] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Telestroke provides access to vascular neurology expertise for hospitals lacking stroke coverage, and its use has risen rapidly in the past decade. We aim to characterize consultations, spoke behavior, and the relationship between spoke telestroke utilization (number of telestroke consults per year) and spoke alteplase treatment metrics in an academic telestroke network. METHODS AND RESULTS We analyzed prospectively collected data on all telestroke consults from 2003 to 2018. Trends in network performance and spoke characteristics were analyzed using generalized estimating equations and Kendall τβ nonparametric tests as appropriate. Unadjusted and adjusted linear regression models determined associations between telestroke utilization and treatment metrics. The network included 2 hubs and 43 spokes with 12 803 consults performed during the study period. Network growth overall was +1.8 spokes per year, and median duration of spoke participation was 7.9 years. The numbers of consults and alteplase-treated patients increased annually, even after adjusting for the number of spokes in the network (P<0.01 for both). Although times from last seen well to spoke emergency department arrival and to consult request increased, door-to-needle time, time from teleconsult request to callback, and time from teleconsult to alteplase administration all decreased (all P<0.01). With time, the network included more spokes without a Primary Stroke Center designation. In adjusted analyses, for every 10 telestroke consults requested by a spoke, the spoke door-to-needle decreased by 1.8 minutes (P=0.02), number of patients treated with alteplase was an additional 1.7 (P<0.01), and the percent of eligible patients treated with alteplase increased by 8% (P=0.03). CONCLUSIONS Telestroke network size and utilization increased over time. Increased use of teleconsults was associated with increased and timely use of alteplase. Over time, the delivery of timely emergency care has improved significantly among emergency departments participating in this telestroke network. Replication of these findings in other networks is warranted.
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Affiliation(s)
- Richa Sharma
- Dept of Neurology, Yale University School of Medicine
| | | | - Anand Viswanathan
- Dept of Neurology, Comprehensive Stroke Center, Fireman Vascular Center, Massachusetts General Hospital
| | - Marcelo Matiello
- Dept of Neurology, Comprehensive Stroke Center, Fireman Vascular Center, Massachusetts General Hospital
| | - Juan Estrada
- Dept of Neurology, Comprehensive Stroke Center, Fireman Vascular Center, Massachusetts General Hospital
| | - Christopher D. Anderson
- Dept of Neurology, Comprehensive Stroke Center, Fireman Vascular Center, Massachusetts General Hospital
| | - Mark Etherton
- Dept of Neurology, Comprehensive Stroke Center, Fireman Vascular Center, Massachusetts General Hospital
| | - Scott Silverman
- Dept of Neurology, Comprehensive Stroke Center, Fireman Vascular Center, Massachusetts General Hospital
| | - Natalia S. Rost
- Dept of Neurology, Comprehensive Stroke Center, Fireman Vascular Center, Massachusetts General Hospital
| | | | - Lee H. Schwamm
- Dept of Neurology, Comprehensive Stroke Center, Fireman Vascular Center, Massachusetts General Hospital
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Chaffin HM, Nakagawa K, Koenig MA. Impact of Statewide Telestroke Network on Acute Stroke Treatment in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2019; 78:280-286. [PMID: 31501825 PMCID: PMC6731184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Hawai'i faces unique challenges in providing access to subspecialty care, particularly on the islands outside of O'ahu. Telemedicine allows remote treatment of patients with acute ischemic stroke by a neurologist with stroke expertise. The Hawai'i Telestroke Program was implemented in 2012 to connect hospitals with limited neurology coverage to a tertiary stroke center on O'ahu with 24/7 stroke neurology coverage. By 2017, seven hospitals were included in the program. The clinical data and revascularization therapy rate for all telestroke cases between January 2012 and July 2017 were analyzed. Annual telestroke consultations increased from 11 in 2012 to 203 in 2016. Among a total of 490 telestroke consultations, 318 patients (64.9%) were diagnosed with ischemic stroke while the remaining 172 patients had other diagnoses. Revascularization therapies, including intravenous tissue plasminogen activator and mechanical thrombectomy, were provided in 190 patients (38.8%). Using the discharge modified Rankin Scale, 141 (44.3%) patients were functionally independent at the time of hospital discharge, while 162 (50.9%) were disabled or dependent, and 15 (4.7%) died while in the hospital. Of the 490 telestroke consultations, 151 patients (30.8%) were transferred to the hub hospital while 69.2% of patients were able to remain in their local hospital. In summary, development of the Hawai'i Telestroke Program resulted in an increasing number of acute telestroke consultations and revascularization therapies at seven hospitals with limited neurological subspecialty coverage. Utilization of telemedicine in acute stroke treatment is feasible and may help address existing disparities of subspecialty care in Hawai'i.
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Affiliation(s)
- Hally M Chaffin
- The Queen's Medical Center, Neuroscience Institute, Honolulu, HI (HMC, KN, MAK)
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (KN, MAK)
| | - Kazuma Nakagawa
- The Queen's Medical Center, Neuroscience Institute, Honolulu, HI (HMC, KN, MAK)
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (KN, MAK)
| | - Matthew A Koenig
- The Queen's Medical Center, Neuroscience Institute, Honolulu, HI (HMC, KN, MAK)
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (KN, MAK)
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Ischemic Stroke Transfer Patterns in the Northeast United States. J Stroke Cerebrovasc Dis 2018; 28:295-304. [PMID: 30389376 DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/29/2018] [Accepted: 09/28/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Little is known about how hospitals are connected in the transfer of ischemic stroke (IS) patients. We aimed to describe differences in characteristics of transferred versus nontransferred patients and between transferring and receiving hospitals in the Northeastern United States, and to describe changes over time. METHODS We used Medicare claims data, and a subset linked with the Get with the Guidelines-Stroke registry from 2007 to 2011. Receiving hospitals were those with annual IS volume greater than or equal to 120 and greater than or equal to 15% received as transfers, and transferring hospitals were nonaccepting hospitals that transferred greater than or equal to 15% of their total (ED plus inpatient) IS patient discharges. A transferring-to-receiving hospital connection was identified if greater than or equal to 5 patients per year were shared. ArcGIS 10.3.1 was used for network visualization. RESULTS Among 177,270 admissions to 402 Northeast hospitals, 6906 (3.9%) patients were transferred. Transferred patients were younger with more severe strokes (78 versus 81 years, P < .001; National Institutes of Health Stroke Severity 7 versus 5, P < .001), and were as likely to receive tissue plasminogen activator as nontransferred (P = .29). From 2007 to 2011, there were more patients transferred (960 [3%] to 1777 [6%], P < .001), and more transferring hospitals (46 [12%] to 91 [24%], P < .001), and receiving hospitals (6 [2%] to 16 [4%], P < .001). Most transferring hospitals were exclusively connected to a single receiving hospital. CONCLUSIONS From 2007 to 2011, hospitals in the United States Northeast became more connected in the care of IS patients, with increasing patient transfers and hospital connections. Yet most hospitals remained unconnected. Further characterization of this transfer network will be important for understanding and improving regional stroke systems of care.
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Gurav SK, Zirpe KG, Wadia RS, Naniwadekar A, Pote PU, Tungenwar A, Deshmukh AM, Mohopatra S, Nimavat B, Surywanshi P. Impact of "Stroke Code"-Rapid Response Team: An Attempt to Improve Intravenous Thrombolysis Rate and to Shorten Door-to-Needle Time in Acute Ischemic Stroke. Indian J Crit Care Med 2018; 22:243-248. [PMID: 29743763 PMCID: PMC5930528 DOI: 10.4103/ijccm.ijccm_504_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: “Stroke code” (SC) implementation in hospitals can improve the rate of thrombolysis and the timeline in care of stroke patient. Materials and Methods: A prospective data of patients treated for acute ischemic stroke (AIS) after implementation of “SC” (post-SC era) were analyzed (2015–2016) and compared with the retrospective data of patients treated in the “pre-SC era.” Parameters such as symptom-to-door, door-to-physician, door-to-imaging, door-to-needle (DTN), and symptom-to-needle time were calculated. The severity of stroke was calculated using the National Institutes of Health Stroke Score (NIHSS) before and after treatment. Results: Patients presented with stroke symptoms in pre- and post-SC era (695 vs. 610) and, out of these, patients who came in window period constituted 148 (21%) and 210 (34%), respectively. Patients thrombolyzed in pre- and post-SC era were 44 (29.7%) and 65 (44.52%), respectively. Average DTN time was 104.95 min in pre-SC era and reduced to 67.28 min (P < 0.001) post-SC implementation. Percentage of patients thrombolyzed within DTN time ≤60 min in pre-SC era and SC era was 15.90% and 55.38%, respectively. Conclusion: Implementation of SC helped us to increase thrombolysis rate in AIS and decrease DTN time.
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Affiliation(s)
- Sushma K Gurav
- Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Kapil G Zirpe
- Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - R S Wadia
- Department of Neurology, Ruby Hall Clinic, Pune, Maharashtra, India.,Deapartment of Medicine, BJMC, Pune, Maharashtra, India
| | | | - Prajakta U Pote
- Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Amit Tungenwar
- Resident General Medicine, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | - Srikanta Mohopatra
- Department of Accident and Emergency, Ruby Hall Clinic, Pune, Maharashtra, India
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Zerna C, Jeerakathil T, Hill MD. Telehealth for Remote Stroke Management. Can J Cardiol 2017; 34:889-896. [PMID: 29459240 DOI: 10.1016/j.cjca.2017.12.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/14/2017] [Accepted: 12/17/2017] [Indexed: 11/16/2022] Open
Abstract
Stroke is a leading cause of adult disability and the fourth leading cause of death in Canada. Most strokes are ischemic and functional outcome is highly time-dependent, making fast diagnosis and treatment initiation crucial. This poses a challenge in vast geographical areas where stroke neurology expertise is only available in urban centres. In this article we review the rationale for telestroke networks and their current implementation in Canada. Telestroke networks enable stroke-specific procedures to be performed by less experienced physicians under the guidance of stroke neurology experts. We also present evidence that the safety and effectiveness of intravenous alteplase in community hospitals in a telestroke network seems to be comparable with that achieved in dedicated stroke centres. It is thus a viable option to guarantee an aging population access to stroke care across large geographic regions with faster treatment and access to more advanced treatment options by means of transfer to a comprehensive centre if necessary. Although telestroke networks have an upfront implementation cost, they can lead to reduced direct and indirect costs for the health care system by reducing days spent in the hospital as well as disability with the need for long-term care. Telestroke networks can also be used for identification and enrollment of patients into emergency stroke trials and thus provide a more representative sample of the population and increase recruitment. Standardization of regional telestroke networks could lead to collaborations with larger data acquisitions for research purposes and quality control in the future.
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Affiliation(s)
- Charlotte Zerna
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Thomas Jeerakathil
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
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Moreno A, Schwamm LH, Siddiqui KA, Viswanathan A, Whitney C, Rost N, Zachrison KS. Frequent Hub-Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network. Telemed J E Health 2017; 24:678-683. [PMID: 29271703 DOI: 10.1089/tmj.2017.0252] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND For acute ischemic stroke patients, shorter time to thrombolytic (tissue plasminogen activator [tPA]) is associated with improved outcomes. INTRODUCTION Telestroke increases tPA use at spoke hospitals, yet its effect on door-to-needle (DTN) times for tPA administration is unknown. We hypothesize that spoke hospitals with more frequent contact to a hub hospital will have shorter DTN times than those with less frequent contact. MATERIALS AND METHODS We identified 375 patients treated with tPA by conventional or telestroke methods in an academic hub-and-spoke telestroke network for whom date and time data were available. Strength of the spoke-hub connection was the primary predictor variable, defined as the number of all telestroke consults (tPA and non-tPA) done at each spoke hospital during the year of the patient's presentation. Patient-level regression analyses examined the relationship between DTN time and spoke-hub connection during the year of the patient's presentation, controlling for temporal trends and clustering within hospitals. RESULTS Sixteen spoke hospitals contributed data on 375 tPA-treated patients from 2006-2015. Hospitals treated a median of 13.5 patients with tPA per year; median hospital-level DTN was 78.8 min (interquartile range [IQR] 71.3-85). Median number of telestroke consults per year was 34 (range 3-137). Among all 375 patients, median DTN was 76 min (IQR 60-97). Strength of spoke-hub connection was significantly associated with faster DTN time for patients (1.3 min gain per 10 additional consults, p = 0.048). CONCLUSIONS More frequent contact between a telestroke spoke and its hub was associated with faster tPA delivery for patients, even after accounting for secular trends in DTN improvements.
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Affiliation(s)
| | - Lee H Schwamm
- 2 Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts
| | - Khawja A Siddiqui
- 3 Department of Neurology, Baylor School of Medicine , Houston, Texas
| | - Anand Viswanathan
- 2 Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts
| | - Cynthia Whitney
- 2 Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts
| | - Natalia Rost
- 2 Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts
| | - Kori Sauser Zachrison
- 4 Department of Emergency Medicine, Massachusetts General Hospital , Boston, Massachusetts
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