Abstract WMP68: Smartphone Support System for Mobile Imaging Display and Management of Acute Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kristina Shkirkova ◽  
Eftitan Y Akam ◽  
Josephine F Huang ◽  
Sunil A Sheth ◽  
May Nour ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Integrated System ◽  
Ease Of Use ◽  
Imaging Data ◽  
Acute Stroke Care ◽  
Team Members ◽  
Information Platform ◽  
Stroke Team

Introduction: Rapid dissemination and coordination of clinical and imaging data among multidisciplinary team members is essential for optimal acute stroke care. Standard desktop EMRs are ill-suited for this purpose, but mobile smartphone and tablet applications are highly promising platforms for accelerated, data-driven patient diagnosis and treatment. This study tested an advanced mobile integrated system for distribution of patient clinical and imaging information. Methods: We tested the iStroke/Synapse ERm system (Figure) for smartphone and tablet display and integration of clinical data, CT, MR, and catheter angiographic imaging, and real-time stroke team communications, in consecutive acute neurovascular patients at a Comprehensive Stroke Center. Results: From 5/2014 to 10/2014, the Synapse ERm application was installed and used by 33 stroke team members, in 84 Code Stroke ED patients. Patient age was 69.1 (±17.5), with 40.5% female. Final diagnosis was: ischemic stroke 66%, TIA 7%, ICH 6%, and CV mimic 21%. Each patient record was viewed on average 13 times by at least 3 team members. The most used feature was CT, MR and cath angio image display, viewed on average 4 times per patient by at least 2 users. In-app tweet team communications were sent by average 2 users per case and viewed by average 6 team members. Use of the system was associated with treatment times that exceeded national guideline targets for thrombolysis and endovascular thrombectomy, including door-to-needle 50 min (IQR 24-60) and door-to-groin 92 min (IQR 65-128). In user surveys, the mobile information platform was judged easy to employ in 91% of uses and of added help in stroke management in a substantial majority of cases. Conclusion: The Synapse ERm system, a smartphone/tablet platform for stroke team communication and distribution and integration of clinical and imaging data, showed high ease of use, substantial added management value, and association with rapid processes of care.

scholarly journals Measuring Patient Safety Climate in Acute Stroke Therapy

2021 ◽  
Vol 12 ◽  
Author(s):  
Ferdinand O. Bohmann ◽  
Joachim Guenther ◽  
Katharina Gruber ◽  
Tanja Manser ◽  
Helmuth Steinmetz ◽  
...  
Keyword(s):  
Patient Safety ◽  
Acute Stroke ◽  
Safety Climate ◽  
Stroke Care ◽  
University Hospitals ◽  
Acute Stroke Care ◽  
Safety Attitudes ◽  
Patient Safety Climate ◽  
Stroke Team ◽  
First Time

Background: Treatment of acute stroke is highly time-dependent and performed by a multiprofessional, interdisciplinary team. Interface problems are expectable and issues relevant to patient safety are omnipresent. The Safety Attitudes Questionnaire (SAQ) is a validated and widely used instrument to measure patient safety climate. The objective of this study was to evaluate the SAQ for the first time in the context of acute stroke care.Methods: A survey was carried out during the STREAM trial (NCT 032282) at seven university hospitals in Germany from October 2017 to October 2018. The anonymous survey included 33 questions (5-point Likert scale, 1 = disagree to 5 = agree) and addressed the entire multiprofessional stroke team. Statistical analyses were used to examine psychometric properties as well as descriptive findings.Results: 164 questionnaires were completed yielding a response rate of 66.4%. 67.7% of respondents were physicians and 25.0% were nurses. Confirmatory Factor Analysis revealed that the original 6-factor structure fits the data adequately. The SAQ for acute stroke care showed strong internal consistency (α = 0.88). Exploratory analysis revealed differences in scores on the SAQ dimensions when comparing physicians to nurses and when comparing physicians according to their duration of professional experience.Conclusion: The SAQ is a helpful and well-applicable tool to measure patient safety in acute stroke care. In comparison to other high-risk fields in medicine, patient safety climate in acute stroke care seems to be on a similar level with the potential for further improvements.Trial registration:www.ClinicalTrials.gov Identifier: NCT032282.

The impact of tele-neurologists on acute stroke care at an advanced primary stroke centre

2020 ◽  
pp. 1357633X2092103
Author(s):  
Scott Gutovitz ◽  
Jonathan Leggett ◽  
Leslie Hart ◽  
Samuel M Leaman ◽  
Heather James ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Care Guidelines ◽  
Stroke Center ◽  
The Impact ◽  
Stroke Centre

Introduction We evaluated the impact of tele-neurologists on the time to initiating acute stroke care versus traditional bedside neurologists at an advanced stroke center. Methods This observational study evaluated time to treatment for acute stroke patients at a single hospital, certified as an advanced primary stroke centre, with thrombectomy capabilities. Consecutive stroke alert patients between 1 March, 2016 and 31 March, 2018 were divided into two groups based on their neurology consultation service (bedside neurology: 1 March, 2016–28 February, 2017; tele-neurology: 1 April, 2017–31 March, 2018). Door-to-tPA time and door-to-IR time for mechanical thrombectomy were compared between the two groups. Results Nine hundred and fifty-nine stroke patients met the inclusion criteria (436 bedside neurology, 523 tele-neurology patients). There were no significant differences in sex, age, or stroke final diagnosis between groups ( p > 0.05). 85 bedside neurology patients received tPA and 35 had mechanical thrombectomy, 84 and 44 for the tele-neurology group respectively. Door-to-tPA time (median (IQR)) was significantly higher among tele-neurology (64 min (51.5–83.5)) than bedside neurology patients (45 min (34–69); p < 0.0001). There was no difference in door-to-IR times (mean ± SD) between bedside neurology (87.2 ± 33.3 min) and tele-neurology (90.4 ± 33.4 min; p = 0.67). Discussion At this facility, our tele-neurology services vendor was associated with a statistically significant delay in tPA administration compared with bedside neurologists. There was no difference in door-to-IR times. Delays in tPA administration make it harder to meet acute stroke care guidelines and could worsen patient outcomes.

Abstract WP259: Simulation Based Medical Education in Interprofessional Education: Acute Stroke Management Model

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Brett Johnson ◽  
Leann Horsley ◽  
Trent Reed ◽  
Donna Quinones ◽  
Viva Siddall ◽  
...  
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Acute Stroke ◽  
Team Performance ◽  
Interprofessional Education ◽  
Stroke Care ◽  
Stroke Management ◽  
Acute Stroke Care ◽  
Stroke Team ◽  
Simulation Based

Introduction: Simulation-based medical education (SBME) is an established tool for training and certifying providers for critical situations such as ACLS. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is a program developed by the Agency for Healthcare Research and Quality and the Department of Defense to improve teamwork. Previous work has demonstrated the effectiveness of SBME in stroke team performance among neurology residents and ICU nurses. Our aim was to develop an SBME interprofessional education (IPE) program for nursing and medical students on stroke team performance. Method: Using a quantitative descriptive one group pretest/posttest design, acute stroke care (14 items), TeamSTEPPS knowledge (14 items) and attitudes toward IPE (16 items) were assessed. After the initial survey, students were given modules on acute stroke care and TeamSTEPPS. Students were randomly assigned into small mixed groups before participating in 2 high-fidelity simulations: an IV tPA-eligible ischemic stroke and a warfarin-associated ICH requiring INR reversal. During each case, trained faculty assessed students using a standardized checklist focusing on stroke management and teamwork. Faculty underwent inter-rater reliability and recalibration training prior to participation. A standardized debriefing was conducted immediately after each case. A 1-hour reinforced learning session was provided by physician and nursing experts in stroke and TeamSTEPPS between cases. Result: 65 nursing and 26 medical students participated. Improvement was seen in the cognitive assessment ( p <0.0001 for composite score) and each affective item ( p <0.0001) after SBME. Psychomotor scores improved ( p <0.01) in most items on the team performance checklist and improved for 5 items on the stroke task checklist. Conclusion: SBME is feasible and effective for supporting IPE in team-based stroke training among nursing and medical students. Although impact on real-world metrics such as door-to-needle time and protocol deviation remains uncertain, SBME using TeamSTEPPS principles should be incorporated within stroke education curricula. Moreover, a stroke code certification process similar to ACLS should be contemplated.

scholarly journals Effect of COVID-19 on Emergent Stroke Care

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
Author(s):  
Jessica Hsiao ◽  
Emily Sayles ◽  
Eleni Antzoulatos ◽  
Robert J. Stanton ◽  
Heidi Sucharew ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Mitigation Measures ◽  
Acute Stroke Care ◽  
Healthcare Facilities ◽  
Stroke Team ◽  
Before And After ◽  
Prior Stroke ◽  
Hospital Capacities ◽  
Mortality Analysis

Background and Purpose: Anecdotal evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic mitigation efforts may inadvertently discourage patients from seeking treatment for stroke with resultant increased morbidity and mortality. Analysis of regional data, while hospital capacities for acute stroke care remained fully available, offers an opportunity to assess this. We report regional Stroke Team acute activations and reperfusion treatments during COVID-19 mitigation activities. Methods: Using case log data prospectively collected by a Stroke Team exclusively serving ≈2 million inhabitants and 30 healthcare facilities, we retrospectively reviewed volumes of consultations and reperfusion treatments for acute ischemic stroke. We compared volumes before and after announcements of COVID-19 mitigation measures and the prior calendar year. Results: Compared with the 10 weeks prior, stroke consultations declined by 39% (95% CI, 32%–46%) in the 5 weeks after announcement of statewide school and restaurant closures in Ohio, Kentucky, and Indiana. Results compared with the prior year and time trend analyses were consistent. Reperfusion treatments also appeared to decline by 31% (95% CI, 3%–51%), and specifically thrombolysis by 33% (95% CI, 4%–55%), but this finding had less precision. Conclusions: Upon the announcement of measures to mitigate COVID-19, regional acute stroke consultations declined significantly. Reperfusion treatment rates, particularly thrombolysis, also appeared to decline qualitatively, and this finding requires further study. Urgent public education is necessary to mitigate a possible crisis of avoiding essential emergency care due to COVID-19.

scholarly journals Identification of Stroke Mimics in the Emergency Department Setting

2009 ◽  
Vol 1 ◽  
pp. JCNSD.S2280 ◽  
Author(s):  
W. Oliver Tobin ◽  
Joseph G. Hentz ◽  
Bentley J. Bobrow ◽  
Bart M. Demaerschalk
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Clinical Predictors ◽  
Acute Stroke Care ◽  
Stroke Mimics ◽  
Emergency Department Setting ◽  
Multivariable Regression ◽  
Stroke Mimic ◽  
Stroke Centre

Background and Purpose Previous studies have shown a stroke mimic rate of 9%–31%. We aimed to establish the proportion of stroke mimics amongst suspected acute strokes, to clarify the aetiology of stroke mimic and to develop a prediction model to identify stroke mimics. Methods This was a retrospective cohort observational study. Consecutive “stroke alert” patients were identified over nine months in a primary stroke centre. 31 variables were collected. Final diagnosis was defined as “stroke” or “stroke mimic”. Multivariable regression analysis was used to define clinical predictors of stroke mimic. Results 206 patients were reviewed. 22% were classified as stroke mimics. Multivariable scoring did not help in identification of stroke mimics. 99.5% of patients had a neurological diagnosis at final diagnosis. Discussion 22% of patients with suspected acute stroke had a stroke mimic. The aetiology of stroke mimics was varied, with seizure, encephalopathy, syncope and migraine being commonest. Multivariable scoring for identification of stroke mimics is not feasible. 99.5% of patients had a neurological diagnosis. This strengthens the case for the involvement of stroke neurologists/stroke physicians in acute stroke care.

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