Communication and Teamwork During Telemedicine-Enabled Stroke Care in an Ambulance

2021 ◽  
pp. 001872082199568
Author(s):  
Anjali Joseph ◽  
Kapil Chalil Madathil ◽  
Roxana Jafarifiroozabadi ◽  
Hunter Rogers ◽  
Sahar Mihandoust ◽  
...  
Keyword(s):  
Care Delivery ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Verbal Interactions ◽  
Effective Coverage ◽  
Team Members ◽  
Video Recordings ◽  
Communication Events ◽  
Team Interactions ◽  
Video And Audio

Objective The purpose of this study is to understand the communication among care teams during telemedicine-enabled stroke consults in an ambulance. Background Telemedicine can have a significant impact on acute stroke care by enabling timely intervention in an ambulance before a patient reaches the hospital. However, limited research has been conducted on understanding and supporting team communication during the care delivery process for telemedicine-enabled stroke care in an ambulance. Method Video recordings of 13 simulated stroke telemedicine consults conducted in an ambulance were coded to document the tasks, communication events, and flow disruptions during the telemedicine-enabled stroke care delivery process. Results The majority (82%) of all team interactions in telemedicine-enabled stroke care involved verbal interactions among team members. The neurologist, patient, and paramedic were almost equally involved in team interactions during stroke care, though the neurologist initiated 48% of all verbal interactions. Disruptions were observed in 8% of interactions, and communication-related issues contributed to 44%, with interruptions and environmental hazards being other reasons for disruptions in interactions during telemedicine-enabled stroke care. Conclusion Successful telemedicine-enabled stroke care involves supporting both verbal and nonverbal communication among all team members using video and audio systems to provide effective coverage of the patient for the clinicians as well as vice versa. Application This study provides a deeper understanding of team interactions during telemedicine-enabled stroke care that is essential for designing effective systems to support teamwork.

scholarly journals Disabling stroke in persons already with a disability

Neurology ◽  
2020 ◽  
Vol 94 (7) ◽  
pp. 306-310 ◽  
Author(s):  
Michael J. Young ◽  
Robert W. Regenhardt ◽  
Thabele M. Leslie-Mazwi ◽  
Michael Ashley Stein
Keyword(s):  
Clinical Practice ◽  
Health Outcomes ◽  
Acute Stroke ◽  
Care Delivery ◽  
Stroke Care ◽  
Clinical Practices ◽  
Acute Stroke Care ◽  
Persons With Disabilities ◽  
Stroke Research ◽  
Scant Attention

Stroke is the second leading cause of death worldwide and a leading cause of adult disability worldwide. More than a third of individuals presenting with strokes are estimated to have a preexisting disability. Despite unprecedented advances in stroke research and clinical practice over the past decade, approaches to acute stroke care for persons with preexisting disability have received scant attention. Current standards of research and clinical practice are influenced by an underexplored range of biases that may hinder acute stroke care for persons with disability. These trends may exacerbate unequal health outcomes by rendering novel stroke therapies inaccessible to many persons with disabilities. Here, we explore the underpinnings and implications of biases involving persons with disability in stroke research and practice. Recent insights from bioethics, disability rights, and health law are explained and critically evaluated in the context of prevailing research and clinical practices. Allowing disability to drive decisions to withhold acute stroke interventions may perpetuate disparate health outcomes and undermine ethically resilient stroke care. Advocacy for inclusion of persons with disability in future stroke trials can improve equity in stroke care delivery.

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.

Abstract 352: Early Data From an Implementation Science Study Suggests the Need for Identification and Adoption of Best Practices to Improve the Timeliness of Stroke Treatment

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Lisa M Monk
Keyword(s):  
Best Practices ◽  
Acute Stroke ◽  
Care Delivery ◽  
Stroke Care ◽  
Early Data ◽  
Screening Tools ◽  
Stroke Severity ◽  
Ct Scanner ◽  
Acute Stroke Care ◽  
Stroke Treatment

There is a disconnect from discovery of best treatment options and application into clinical practice in a timely manner. The I M plementation of best Pr actices f O r acute stroke care-de v eloping and optimizing regional systems of Stroke Care (IMPROVE Stroke Care) goal is to develop a regional integrated stroke system that identifies, classifies, and treats patients with acute ischemic stroke more rapidly and effectively with reperfusion therapy. These improvements in acute stroke care delivery are expected to result in lower mortality, fewer recurrent strokes, and improved long term functional outcomes. Recent discoveries in stroke care and advancement in technology extends the window for both TPA administration and mechanical thombectomy. The challenge of implementing these latest advances are difficult considering the ability of hospitals to implement the original American Heart Association (AHA) Systems of Stroke Care recommendations. Early data from this project shows that the challenges continue to exist in recommendations that have been in place as early as 2005. EMS is not utilizing pre-hospital stroke screening tools, only 5% of the time, stroke severity tools, only 7% of the time, lytic checklists, 0% of the time, destination decision changed due to severity score, 0% of the time, and pre-notifying emergency rooms, only 63% of the time. Emergency departments door to CT <45 minutes, only 55% of the time, Lytic given in CT scanner, only 35% of the time, Door to lytic therapy< 45 minutes, 77% of the time, Door to Groin puncture, 81% of the time, and Door to TICI Flow 2c/3 flow <90 minutes, 39% of the time. The Systems of Stroke Care have recommendations that will improve time to treatment and outcomes for patients. This project is working to provide tools, guidance, data, and feedback to improve application of these recommendations and identify best practices and solutions to barriers.

Can Process Metrics Predict Product Success?: A Pilot Study of Student Design Teams

2019 ◽  
Author(s):  
Jennifer Bracken ◽  
Francis Xavier Glavin ◽  
Daniel Henderson ◽  
Kathryn Jablokow ◽  
Neeraj Sonalkar ◽  
...  
Keyword(s):  
Design Teams ◽  
Team Members ◽  
Product Success ◽  
Team Interactions ◽  
Successful Team ◽  
The Subject ◽  
Video And Audio ◽  
Using Data ◽  
Engineering Projects

Abstract Engineering projects typically revolve around producing a deliverable. That deliverable goes to a customer, who either deems it acceptable or in need of further work. The engineering analysis and components of whatever system is to be produced are the subject of much scrutiny. However, the human process composed of team interactions that lead up to creating that final product is frequently treated as a “black box” that simply produces an output. In order to identify what factors in that process are key to a successful product, this work seeks to identify what successful engineering design teams do differently than less successful teams. As part of our larger research project, metrics for measuring team performance during the process of design have also been created. In this paper, we use three of those metrics in a case study of 5 senior-level student design teams. These data are employed in conjunction with feedback from the instructor, acting as their customer, to identify which behaviors had strong links with more successful team results. We also investigate whether any of the behaviors exhibited by the teams correspond to worse results, in order to identify behaviors with the potential to be used to predict poorer performance in advance. This analysis is completed using data collected via a mid-term survey and an end-of-project survey (both completed by the team members), in addition to video and audio meeting data, and data collected from both midterm and final presentations. We present these results as an avenue to move us towards enabling engineers to choose to engage knowingly in behaviors that correlate with better project results.

Abstract TP345: Improving Door to Drug Times for Ischemic Stroke Patients Using a Team Approach

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Denise Sorenson ◽  
Alyson Flood
Keyword(s):  
Ischemic Stroke ◽  
Best Practice ◽  
Stroke Care ◽  
Team Approach ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Stakeholder Collaboration ◽  
Team Members ◽  
Team Meetings ◽  
Team Motivation

Background and Purpose: Decreasing door to drug times for ischemic stroke patients has been proven to optimize preservation of brain tissue, resulting in better functional outcomes. In prior years, the stroke team focus was to meet or exceed the 50% goal for the Joint Commission measure; patients arriving within 2 hours of last known well receive alteplase within 180 minutes. In the fall of 2011, the Neuroscience Medical Director challenged the team to meet target stroke goals and achieve the gold standard of excellence. Methods: Guided by the Plan Do Study Act model and principles of shared governance, the team refocused efforts to enhance stakeholder collaboration, educate, and provide monthly evaluation of door to door times. Code Stroke pathways were revised to improve efficiency, and inclusion / exclusion criteria were revised. The team is presented with state and national benchmark best practice data on an ongoing basis. Individual alteplase case feedback sheets are sent to all involved providers and departments, who are encouraged to provide input into the process. All alteplase cases are reviewed during team meetings, and outcomes are shared. Role modeling, physician engagement, positive feedback to team members and celebration of successes instill team motivation and confidence. In June, the program hosted an inaugural Stroke Symposium, where national speakers shared the ‘state of the science’, validating the rationale for improving processes for acute stroke care. Results: In the first 6 months of 2012, the median door to drug time was reduced by 48% to 55 minutes from 104 minutes in 2011. In the same time period, 10 of 15 patients had alteplase administered in < 60 minutes, versus 2 of 25 in 2011. Conclusions: Significant improvements in stroke care can be gained by establishing a cohesive team with a shared goal of excellence. Strong leadership, the ability of staff on all levels to be partners in decision making, information sharing, education and recognition are keys to success. Future challenges include ensuring the processes are sustainable, and maintaining team motivation to continue to find opportunities to reduce door to drug times.

Abstract P863: Did Covid 19 Highlight Disparities in Stroke Care: A Real-World Study of Telehealth Utilization Between Urban and Suburban Populations in a Health Care System

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Maryika I Gibson ◽  
Ruchi Wanchoo
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Care Delivery ◽  
Small Sample Size ◽  
National Level ◽  
Stroke Care ◽  
Small Sample ◽  
Acute Stroke Care ◽  
Significant Difference ◽  
Care System

A viable alternative to in person assessments, telemedicine offered providers cost effective and safe alternative to patient care delivery during COVID19. Resource limitations, state and organizational safety precautions accelerated our system adoption of video visits for stroke post hospitalization assessments. Utilizing mixed methods we aimed to investigate an association between patients characteristics (age, gender, race, Modified Rankin Score-mRS, residence) and their choice for post-acute care during a five-month period. The subset selecting in-person visits was further interviewed regarding perceptions of barriers to telehealth. We analyzed data from 85 patients’ records (45 in the urban telehealth and 40 in the suburban clinic visit groups) according to ICD10 codes. While total volume of televisits increased during COVID 19, stroke accounted for <1% of them. There was no significant difference in the mean age between the two groups-68.5 years in the clinic and 64.4 in the tele. The clinic subset had 42% of patients age greater than 75 years. Significant difference was detected in disabilities (t=3.5, p<.001) with one-point higher mean mRS (1.7 vs .7) and stronger positive correlation of age to disabilities in the suburban group (r2=.26 vs r2=.16). Patients selecting in-person care outlined as barriers to telehealth a lack of technology, poor connectivity, no caregiver availability for tele exam, inability to communicate or other major co-morbidities, family’s perception of complexity of patient’s condition, fragmentation of care during the period. Patients selecting video assessment were more connected with a health care system and from the urban center. Strengths of the study are the application of mix methods and investigation of suburban patients’ perceptions of barriers to telehealth. Limitations consist of small sample size and 90% Caucasian population. Current technology advancements, software applications, and the goal of Healthy People 2030 of removing disparities in heart and stroke disease will require a new multipronged approach to improving stroke telehealth at population level. Further studies at national level including social determinates of health need to examine barriers to telemedicine in post-acute stroke care.

scholarly journals Association Between Immigration Status and Acute Stroke Care

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1555-1562
Author(s):  
Manav V. Vyas ◽  
Andreas Laupacis ◽  
Peter C. Austin ◽  
Jiming Fang ◽  
Frank L. Silver ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Care Delivery ◽  
Stroke Care ◽  
Future Research ◽  
Immigration Status ◽  
Acute Stroke Care ◽  
Adjusted Risk ◽  
Ischemic Attack

Background and Purpose— Immigrants to high-income countries have a lower incidence of stroke compared with long-term residents; however, little is known about the care and outcomes of stroke in immigrants. Methods— We used linked clinical and administrative data to conduct a retrospective cohort study of adults seen in the emergency department or hospitalized with ischemic stroke or transient ischemic attack between July 1, 2003, and April 1, 2013, and included in the provincial stroke registry. We ascertained immigration status using immigration records and compared processes of stroke care delivery between immigrants (defined as those immigrating after 1985) and long-term residents. In the subgroup with ischemic stroke, we calculated inverse probability treatment weight (IPTW)–adjusted risk ratios for disability on discharge (modified Rankin Scale score of 3 to 5), accounting for demographic characteristics and comorbid conditions to compare outcomes between immigrants and long-term residents. Results— We included 34 987 patients with ischemic stroke or transient ischemic attack, of whom 2649 (7.6%) were immigrants. Immigrants were younger than long-term residents at the time of stroke/transient ischemic attack (median age 67 years versus 76 years; P <0.001). In the subgroup with ischemic stroke, there were no differences in stroke care delivery, except that a higher proportion of immigrants received thrombolysis than long-term residents (21.2% versus 15.5%; P <0.001). Immigrants with ischemic stroke had a higher adjusted risk of being disabled on discharge (adjusted risk ratio, 1.18; 95% CI, 1.13–1.22) compared to long-term residents. Conclusions— Stroke care is similar in Canadian immigrants and long-term residents. Future research is needed to confirm the observed association between immigration status and disability after stroke and to identify factors underlying the association.

scholarly journals Benchmarks for acute stroke care delivery

2013 ◽  
Vol 25 (6) ◽  
pp. 710-718 ◽  
Author(s):  
R. E. Hall ◽  
F. Khan ◽  
M. T. Bayley ◽  
E. Asllani ◽  
P. Lindsay ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Care Delivery ◽  
Stroke Care ◽  
Acute Stroke Care

Telemedicine Physician Providers: Augmented Acute Stroke Care Delivery in Rural Texas: An Initial Experience

2004 ◽  
Vol 10 (supplement 2) ◽  
pp. S-90-S-94
Author(s):  
John Y. Choi ◽  
Anne W. Wojner ◽  
Robert T. Cale ◽  
Peter Gergen ◽  
Joseph Degioanni ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Care Delivery ◽  
Stroke Care ◽  
Initial Experience ◽  
Acute Stroke Care

Abstract P93: The Effects of Covid-19 on Telestroke Care Delivery

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Johanna L Morton ◽  
Suraj Didwania ◽  
Eric Anderson ◽  
Jason Hallock
Keyword(s):  
Acute Stroke ◽  
Care Delivery ◽  
Stroke Care ◽  
Study Data ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Significant Difference ◽  
Presentation Time ◽  
Stroke Group ◽  
The U.S

Background: Telestroke is increasingly being utilized to deliver acute stroke care to patients without in-person access to stroke expertise. After the U.S. emergence of the COVID-19 pandemic in March of 2020, reports of its effects on acute stroke care surfaced. This review examines the effect of the COVID-19 pandemic on telestroke care delivery in a large telestroke network, spanning 36 states and 340 hospitals throughout the nation. Methods: For this retrospective observational study, data was reported from the internal medical record platform from three separate time periods - a year before the pandemic (March 2019 - May 2019), the three months immediately prior to the pandemic (December 2019 - February 2020), and the height of the COVID-19 pandemic in the U.S. (March 2020 - May 2020). Two groups were studied, those seen in the emergency department (ED) with a suspected stroke diagnosis, and those who received alteplase in the ED. Results: The analysis revealed a decrease in patient volumes in both groups during the pandemic. The presentation time did not significantly vary between any of the stroke or alteplase groups. There was no significant difference in door-to-consult request times in the pandemic vs prior to the pandemic. The door-to-video time was shorter in the pandemic in alteplase patients compared to immediately prior ( P =0.04), but not compared to 2019 ( P =0.35). There was no significant difference in door-to-decision times or door-to-needle times in all of the groups. There was no difference in stroke severity in the alteplase group during the pandemic, but in the stroke group, stroke severity was higher during the pandemic ( P <0.01). Rates of thrombolysis did not decrease during the pandemic. Conclusion: COVID-19 has strained the U.S. emergency medical system and created unique challenges to treating patients with acute ischemic stroke. Likely due to the size and heterogeneity of the patient population, minimal adverse effects on telestroke process metrics were seen in this particular large teleneurology practice during the COVID-19 pandemic. This review highlights the resilience of our nation’s stroke system of care to withstand the stressor of a worldwide pandemic.

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