Abstract W MP100: Applying Real-Time Location Systems to Acute Stroke Workflow: A Novel Quality Improvement Tool

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Adam Prater ◽  
Meredith Bowen ◽  
Emily Pavich ◽  
Thomas Loehfelm ◽  
Aaron M Anderson ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Real Time ◽  
Human Observer ◽  
Ct Scanner ◽  
Urban Hospital ◽  
Ir Detectors ◽  
Arrival Times ◽  
Patient Arrival ◽  
Location Systems

Background: Real-Time Location Systems (RTLS) utilize tracking tags and detectors to locate objects or people. This technology has been implemented in healthcare, chiefly to track hospital assets, and a few healthcare systems have applied this technology to track patients in the emergency department. This pilot study tested the feasibility of RTLS to monitor the acute stroke workflow in a large, urban hospital. Methods: An asset tracking RTLS was installed in a large, urban hospital. A series of 21 acute stroke patients were tracked throughout the workflow process by a human observer and via RTLS asset tag attached to the patient’s hospital equipment. A Wi-Fi detector documented initial patient arrival times in the ER Hallway, radiofrequency/infrared (RFID/IR) detectors documented ER CT scanner and ER patient room times. Patient Arrival and departure times in the emergency room (ER) and radiology CT scanner were measured. Time differences between human observer and RTLS were calculated. Results: A total of 21 patients were tracked with RTLS. The mean time difference, interquartile range and standard deviation in minutes are as follows: initial arrival (mean 106, IQR 112, SD 197); CT arrival ( mean 1, IQR 1, SD 0.86); CT departure (mean 2, IQR 2, SD 1.13); patient return to ED (mean 1, IQR 1, SD 0.94). Discussion: Our data demonstrate that RTLS can provide accurate, real-time patient location information, and has the potential to provide data for quality improvement. Combination RFID/IR detectors provided accurate time information while the Wi-Fi detector, proved unreliable for initial arrival times. Our preliminary data supports the development of an unique RTLS system specifically designed to allow for complete visualization of the stroke workflow from patient arrival to treatment along with a dashboard user interface to facilitate treatment team coordination.

Abstract W P214: Identifying Stroke Symptoms in the Field: What are we Missing?

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Lindsay Olson-Mack ◽  
Darlene Bourdon ◽  
Barbara Kelley ◽  
Jon Ludwig ◽  
Gilda Tafreshi
Keyword(s):  
Acute Stroke ◽  
Rapid Assessment ◽  
Stroke Care ◽  
Further Education ◽  
Urban Hospital ◽  
Acute Stroke Care ◽  
Exclusion Criteria ◽  
Initial Finding ◽  
Patient Arrival ◽  
Iv Tpa

Introduction: Emergency Departments (ED) are increasingly activating stroke codes based on assessment of stroke symptoms via Emergency Medical Services (EMS). Accurate assessment of stroke symptoms by EMS facilitates rapid assessment in the ED, leading to prompt diagnosis and treatment during an acute stroke. Delays in treatment can occur when stroke symptoms are not recognized in the field. Hypothesis: We hypothesized that trends existed in stroke symptoms most commonly missed by EMS. Methods: A retrospective cohort study of 170 records was reviewed, for all patients receiving acute stroke care at an urban hospital from October 2013 to May 2014. Inclusion criteria: stroke code activation by EMS or in the ED, and patient arrival by EMS. Exclusion criteria: stroke code activations after admission to the hospital, and patients arriving via private transportation. Results: 112 patients met the inclusion and exclusion criteria. 90 patients (80%) had stroke codes were initiated by EMS. The remaining 22 patients had stroke codes initiated by the ED MD after arrival. The records of the 22 patients arriving to the ED without advanced EMS notification were reviewed. Aphasia was documented in the EMS record for 8 patients (36%). An additional 8 patients (36%) with documented stroke symptoms arrived without EMS notification due to improving symptoms or unclear last known well time. Five of the 22 patients (23%) arriving without EMS pre-notification had had aaphasia documented as an initial finding by ED MD, had a stroke code activation and received IV tPA. One of the 5 patients (13%) also had improving symptoms documented by EMS. Conclusion: An opportunity exists for improved recognition of aphasia as a stroke symptom by EMS, including both expressive and receptive components. Likewise, further education is needed correlating aphasia with the likelihood of IV tPA initiation in the ED. This study also highlights the importance of recognizing the waxing and waning nature of stroke symptoms. Rapidly improving symptoms should not preclude stroke code initiation via EMS, as some of these patients are still IV tPA candidates.

Enhancing Workflow Analysis in Acute Stroke Patients Using Radiofrequency Identification and Infrared-based Real-Time Location Systems

2017 ◽  
Vol 14 (2) ◽  
pp. 231-234 ◽  
Author(s):  
Adam Prater ◽  
Meredith Bowen ◽  
Emily Pavich ◽  
C. Matthew Hawkins ◽  
Nabile Safdar ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Real Time ◽  
Stroke Patients ◽  
Workflow Analysis ◽  
Radiofrequency Identification ◽  
Location Systems

scholarly journals Near-surface real-time seismic imaging using parsimonious interferometry

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sherif M. Hanafy ◽  
Hussein Hoteit ◽  
Jing Li ◽  
Gerard T. Schuster
Keyword(s):  
Fluid Flow ◽  
Real Time ◽  
Temporal Resolution ◽  
Seismic Imaging ◽  
Time Lapse ◽  
Rock Properties ◽  
Recording Time ◽  
Near Surface ◽  
Arrival Times ◽  
Order Of Magnitude

AbstractResults are presented for real-time seismic imaging of subsurface fluid flow by parsimonious refraction and surface-wave interferometry. Each subsurface velocity image inverted from time-lapse seismic data only requires several minutes of recording time, which is less than the time-scale of the fluid-induced changes in the rock properties. In this sense this is real-time imaging. The images are P-velocity tomograms inverted from the first-arrival times and the S-velocity tomograms inverted from dispersion curves. Compared to conventional seismic imaging, parsimonious interferometry reduces the recording time and increases the temporal resolution of time-lapse seismic images by more than an order-of-magnitude. In our seismic experiment, we recorded 90 sparse data sets over 4.5 h while injecting 12-tons of water into a sand dune. Results show that the percolation of water is mostly along layered boundaries down to a depth of a few meters, which is consistent with our 3D computational fluid flow simulations and laboratory experiments. The significance of parsimonious interferometry is that it provides more than an order-of-magnitude increase of temporal resolution in time-lapse seismic imaging. We believe that real-time seismic imaging will have important applications for non-destructive characterization in environmental, biomedical, and subsurface imaging.

scholarly journals An automatically generated high-resolution earthquake catalogue for the 2016–2017 Central Italy seismic sequence, including P and S phase arrival times

2020 ◽  
Author(s):  
D Spallarossa ◽  
M Cattaneo ◽  
D Scafidi ◽  
M Michele ◽  
L Chiaraluce ◽  
...  
Keyword(s):  
Real Time ◽  
Central Italy ◽  
Earthquake Catalogue ◽  
Hazard Evaluation ◽  
Depth Range ◽  
Data Set ◽  
Epicentral Area ◽  
Earthquake Parameters ◽  
Waveform Data ◽  
Arrival Times

Summary The 2016–17 central Italy earthquake sequence began with the first mainshock near the town of Amatrice on August 24 (MW 6.0), and was followed by two subsequent large events near Visso on October 26 (MW 5.9) and Norcia on October 30 (MW 6.5), plus a cluster of 4 events with MW > 5.0 within few hours on January 18, 2017. The affected area had been monitored before the sequence started by the permanent Italian National Seismic Network (RSNC), and was enhanced during the sequence by temporary stations deployed by the National Institute of Geophysics and Volcanology and the British Geological Survey. By the middle of September, there was a dense network of 155 stations, with a mean separation in the epicentral area of 6–10 km, comparable to the most likely earthquake depth range in the region. This network configuration was kept stable for an entire year, producing 2.5 TB of continuous waveform recordings. Here we describe how this data was used to develop a large and comprehensive earthquake catalogue using the Complete Automatic Seismic Processor (CASP) procedure. This procedure detected more than 450,000 events in the year following the first mainshock, and determined their phase arrival times through an advanced picker engine (RSNI-Picker2), producing a set of about 7 million P- and 10 million S-wave arrival times. These were then used to locate the events using a non-linear location (NLL) algorithm, a 1D velocity model calibrated for the area, and station corrections and then to compute their local magnitudes (ML). The procedure was validated by comparison of the derived data for phase picks and earthquake parameters with a handpicked reference catalogue (hereinafter referred to as ‘RefCat’). The automated procedure takes less than 12 hours on an Intel Core-i7 workstation to analyse the primary waveform data and to detect and locate 3000 events on the most seismically active day of the sequence. This proves the concept that the CASP algorithm can provide effectively real-time data for input into daily operational earthquake forecasts, The results show that there have been significant improvements compared to RefCat obtained in the same period using manual phase picks. The number of detected and located events is higher (from 84,401 to 450,000), the magnitude of completeness is lower (from ML 1.4 to 0.6), and also the number of phase picks is greater with an average number of 72 picked arrival for a ML = 1.4 compared with 30 phases for RefCat using manual phase picking. These propagate into formal uncertainties of ± 0.9km in epicentral location and ± 1.5km in depth for the enhanced catalogue for the vast majority of the events. Together, these provide a significant improvement in the resolution of fine structures such as local planar structures and clusters, in particular the identification of shallow events occurring in parts of the crust previously thought to be inactive. The lower completeness magnitude provides a rich data set for development and testing of analysis techniques of seismic sequences evolution, including real-time, operational monitoring of b-value, time-dependent hazard evaluation and aftershock forecasting.

Abstract 2197: Telestroke: Optimizing Access to Emergency Interventions in Acute Stroke Care

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Rayetta Johnson
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Health Care Providers ◽  
Positive Impact ◽  
Medical Center ◽  
Stroke Care ◽  
Nurse Specialist ◽  
Care Providers ◽  
Acute Stroke Care ◽  
Evidenced Based

Background and Issues: The burden of stroke in North Carolina is one of the highest in the nation (approximately 28,000 stroke hospitalizations from 2003-2007). The number and high costs of stroke have made it incumbent to improve the numbers of patients receiving effective treatment. There are two major barriers for treatment of acute stroke: time and access. The utilization of telestroke in community hospitals aids in decreasing these barriers by providing immediate access to a stroke neurologist. In order for telestroke to be successful, awareness and education regarding acute stroke care must be provided for health care providers as well as the communities. Thus, the development of a telestroke system requires nursing and medical expertise. The Primary Stroke Center Team at Wake Forest Baptist Medical Center in Winston-Salem, N.C. implemented a telestroke network system (Intouch's Health's RP-7 Robotic system) in January of 2010 to provide 24/7 access to the medical center's acute stroke experts and the latest advancements in stroke interventions. There are eight hospitals in the network at the present time. Methods: Our team identified that many of the network hospital's staff are not experienced in taking care of a stroke patient and that a “roadmap” is useful to guide them in these steps.The stroke nurse specialist developed a quality improvement plan for the network hospitals which included: an evidence-based algorithm for patient care; stroke education, in particular, neurological assessment and tPA administration classes for the ED staff; quarterly meetings to provide outcome and feedback data with each network hospital; stroke awareness events for the community. Mock telestroke consults were also performed prior to “going live” with telestroke for each of the network hospitals. Of utmost importance is the early involvement and education of the EMS system in the respective county of the network hospital. The buy-in of EMS was found to be a key component in the success of the network. Finally, attention to customized quality improvement efforts for each of the facilities are required to accomplish integration into the telestroke network. Results: The data has been analyzed, and thus far, a 24% rate of tPA administration has been seen with our network hospitals (an increase from the 3.6% national average). Comparisons between each of the eight network hospitals' rates of administration of tPA prior to and after joining the network show a trend of increase (10%-40%). The effectiveness of the algorithm has also been explored by analysis of feedback and initial results have shown a positive impact. Conclusion: A combination of improving access to stroke neurologists in conjunction with a focus on improving the level of care via evidenced based stroke care teaching and implementation of algorithms at a network hospital is required for implementing and building a successful telestroke network.

Abstract TP362: A Team Approach for Improving Door to needle Time for IV t-PA in Acute Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Nili E Steiner ◽  
Nicole Wolber ◽  
Betty Robertson ◽  
Paula Rosenfield ◽  
Laurie Paletz
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Stroke Patient ◽  
Ct Perfusion ◽  
Team Approach ◽  
Acute Stroke Patient ◽  
Stroke Treatment ◽  
Perfusion Studies ◽  
Intravenous Tissue Plasminogen Activator ◽  
Ct Angiogram

Background: Brain ischemia kills 2 million nerve cells per minute. As time elapses, the odds of favorable outcome become less likely. By providing treatment rapidly, patient outcome is markedly improved. We recognized an opportunity for improvement by shortening our door-to-needle time. The door-to-needle time is defined by the time the patient arrives in the emergency department to the time the patient receives intravenous tissue plasminogen activator (IV t-PA). Methods: We evaluated the system in place to look at opportunities for improvement. We met monthly to assess every acute stroke patient case, particularly to evaluate delays in acute stroke treatment. We analyzed the results of all the acute stroke patient cases from January 2008 to January 2012. We implemented the following interventions: staff education, reducing unnecessary CT angiogram and CT perfusion studies on patients, RN telephone triage for acute stroke patients. pre-hospital activation of the stroke team for patients exhibiting acute stroke symptoms, ED pharmacist at bedside upon patient arrival with t-PA, and placing patients on portable monitors immediately upon ED arrival. Conclusion: The average door-to-needle time from January 2008 to October 2011 was 1 hour and 32 minutes. After implementing the changes above, from November 2011 to January 2012, our average door-to-needle time was 38 minutes to 54 minutes, which is within the target of less than 60 minutes. By implementing these changes, we have successfully and safely reduced and improved our door-to-needle time. Monthly quality improvement meetings are on-going to assess continuing quality improvement.

Estimating physical work-load on ED clinicians and staff using real-time location systems

2021 ◽  
pp. 1-1
Author(s):  
Anoushka Kapoor ◽  
Moein Enayati ◽  
Alisha Chaudhry ◽  
Nasibeh Zanjirani Farahani ◽  
Shivaram P. Arunachalam ◽  
...  
Keyword(s):  
Real Time ◽  
Work Load ◽  
Physical Work ◽  
Physical Work Load ◽  
Location Systems

Abstract 3446: Inpatient Code Stroke Protocol: A Quality Improvement and Knowledge Translation Strategy for a Challenging Scenario

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jacqueline D Willems ◽  
Krsytyna Skrabka ◽  
Roseane Nisenbaum ◽  
Judith Barnaby ◽  
Pawel Kostyrko ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Robust Regression ◽  
Stroke Care ◽  
Initial Assessment ◽  
Stroke Severity ◽  
Care Hospital ◽  
Presenting Symptoms ◽  
Number Of Patients ◽  
Assessment And Treatment

Background: Stroke care faces a clinical challenge in treating inhospital strokes, which account for about 15% of all strokes. Prior studies showed an inequity in the assessment and treatment of inpatients who suffer a stroke versus out-of hospital. For example, inpatients have longer time to initial assessment, CT and are less likely (wait longer) to receive tissue plasminogen activator (t-PA). There is limited research evaluating the efficacy of inpatient code stroke protocols (ICSP) on access to and quality of hyper-acute stroke care. Objective: To evaluate the efficacy of the ICSP in a large tertiary care hospital. Methods: This prospective study evaluated a quality improvement strategy involving ICSP implementation at St Michael’s Hospital in 2009. The ICSP focuses on the identification of stroke symptoms and timely notification of most responsible physician, then leverages the Emergency Department code stroke process. A 3-month hospital-wide implementation period involved 60 min. education sessions with a minimum of 2 sessions per unit. Demographic factors, presenting symptoms, stroke severity, vascular risk factors as well as time of: symptoms onset, CT; and physician assessment were collected by chart abstraction after ethics approval. The primary outcomes was time from last seen normal (LSN) to CT scan. Secondary outcomes include time from LSN to initial assessment (IA), medical complications and number of patients receiving endovascular interventions or intravenous thrombolysis. The analysis was completed by comparing unadjusted and adjusted outcomes pre and post implementation of the ICSP. Descriptive statistics and robust regression was completed using SAS 9.0. Results: Overall, there were 245 inhospital strokes during the study period (152 pre and 93 post ICSP implementation). Mean age was 69.8 yrs, 60% were male. Most inpatient strokes occurred on cardiovascular services (42.9%). Main results summarized in table . There was no difference in the number of patients receiving thrombolysis or endovascular treatment. After adjustment for covariates, the ICS was associated with a significant reduction of 288 minutes (95%CI -566, -10) in time from LSN to CT. Similarly, there was significant reduction of 307 (95%CI -532, -82) in time from LSN to IA. Conclusions: Implementation of the ICSP resulted in improvements in the process indicators related to assessment and treatment of hyper-acute stroke. Similar quality improvement strategies can be implemented to ameliorate disparities between care for inpatients and outpatient presenting with an acute ischemic stroke.

The feasibility and validity of using a real time location system (RTLS) to measure bedside contact time

2021 ◽  
pp. 174498712110161
Author(s):  
Ann-Marie Cannaby ◽  
Vanda Carter ◽  
Thomas Hoe ◽  
Stephenson Strobel ◽  
Elena Ashtari Tafti ◽  
...  
Keyword(s):  
Real Time ◽  
Contact Time ◽  
Measured Data ◽  
Complete Agreement ◽  
Observation Data ◽  
The Real ◽  
Measured Time ◽  
The Difference ◽  
Hospital Wards ◽  
Location Systems

Background The association between the nurse-to-patient ratio and patient outcomes has been extensively investigated. Real time location systems have the potential capability of measuring the actual amount of bedside contact patients receive. Aims This study aimed to determine the feasibility and accuracy of real time location systems as a measure of the amount of contact time that nurses spent in the patients’ bed space. Methods An exploratory, observational, feasibility study was designed to compare the accuracy of data collection between manual observation performed by a researcher and real time location systems data capture capability. Four nurses participated in the study, which took place in 2019 on two hospital wards. They were observed by a researcher while carrying out their work activities for a total of 230 minutes. The amount of time the nurses spent in the patients’ bed space was recorded in 10-minute blocks of time and the real time location systems data were extracted for the same nurse at the time of observation. Data were then analysed for the level of agreement between the observed and the real time location systems measured data, descriptively and graphically using a kernel density and a scatter plot. Results The difference (in minutes) between researcher observed and real time location systems measured data for the 23, 10-minute observation blocks ranged from zero (complete agreement) to 5 minutes. The mean difference between the researcher observed and real time location systems time in the patients’ bed space was one minute (10% of the time). On average, real time location systems measured time in the bed space was longer than the researcher observed time. Conclusions There were good levels of agreement between researcher observation and real time location systems data of the time nurses spend at the bedside. This study confirms that it is feasible to use real time location systems as an accurate measure of the amount of time nurses spend at the patients’ bedside.

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