IntroductionThe mantra “time is brain” has led to significant efforts to expedite tPA administration time and initiation of mechanical thrombectomy for the treatment of ischemic stroke. Evidence supporting surgical intervention for intracerebral hemorrhage (ICH) remains elusive. Numerous clinical trials have had negative overall results and others are still on-going. Most investigators and trial protocols have agreed that intervention should occur rapidly to decrease the risk of hematoma expansion and reduce perihematomal edema, however no trial has directly studied this question. Artificial intelligence applications have been shown to improve ischemic stroke workflow metrics, both decreasing transfer times from outside hospitals and rapidly alerting the interventional teams. We aimed to determine whether the implementation of an ICH detection algorithm that provides immediate active notification to provider cell phones would improve hemorrhagic stroke workflow at our institution.MethodsA retrospective review was performed of patients presenting between January 2018 and March 2022 who suffered a spontaneous ICH and for whom the neurosurgical service was consulted for possible surgical intervention. Stroke workflow metrics were compared pre- and post-implementation of the VizAI (Viz.ai, San Francisco, California, USA) smartphone application. Additional demographic, clinical, and radiographic information was all collected.Results188 adult patients were identified during the study period. Time between identification of ICH to neurosurgical team notification was reduced by 50 minutes after the implementation of VizAI (p<0.002). The number increases to 57 minutes when hemorrhages not identified by the ICH algorithm were excluded.DiscussionActive notification of the neurosurgical team by an artificial intelligence application significantly reduces the time from hemorrhage identification to surgical evaluation. Further studies are needed to evaluate whether this results in a clinical benefit.

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Background: High functioning interprofessional teams may benefit from understanding how well (or not so well) a team is functioning and how teamwork can be improved. A team-based assessment can provide team insight into performance and areas for improvement. Though individual assessment via direct observation is common, few residency programs in the United States have implemented strategies for interprofessional team (IPT) assessments. Methods: We piloted a program evaluation via direct observation for a team-based assessment of an IPT within one Internal Medicine residency program. Our teams included learners from medicine, pharmacy, physician assistant and psychology graduate programs. To assess team performance in a systematic manner, we used a Modified McMaster-Ottawa tool to observe three types of IPT encounters: huddles, patient interactions and precepting discussions with faculty. The tool allowed us to capture team behaviors across various competencies: roles/responsibilities, communication with patient/family, and conflict resolution. We adapted the tool to include qualitative data for field notes by trained observers that added context to our ratings. Results: We observed 222 encounters over four months. Our results support that the team performed well in measures that have been iteratively and intentionally enhanced – role clarification and conflict resolution. However, we observed a lack of consistent incorporation of patient-family preferences into IPT discussions. Our qualitative results show that team collaboration is fostered when we look for opportunities to engage interprofessional learners. Conclusions: Our observations clarify the behaviors and processes that other IPTs can apply to improve collaboration and education. As a pilot, this study helps to inform training programs of the need to develop measures for, not just individual assessment, but also IPT assessment.

BACKGROUND The incidence of brain metastasis is approximately 200,000 worldwide annually. Stereotactic radiation therapy of post-operative cavity reduces local recurrence. Surgical cavity size changes significantly with 96.5% demonstrating volumetric change during post-operative period. We sought to define the optimal time interval that preserved the volumetric dimensions between the post-surgical MRI and the CT simulation used for stereotactic radiosurgery planning. METHODS Seven patients with brain metastasis that underwent surgical resection and stereotactic radiation treatment at Albany Medical Center from February 2019 to April 2020 were included in the study. A total of 8 target lesions were included. Brain lab planning system was used for contouring the target volume. A postoperative MRI within 24-48 hours after surgery was obtained. 3 patients required an additional interim MRI 16-50 days after surgery. The planning CT simulation was performed 2 days prior and up to 15 days after the post-operative/interim MRI and target volumes were compared. RESULTS The average volume of the post-surgical cavity contoured by the neurosurgeons on the post-operative/interim MRI was 15.96 cc (± 7.79 cc, range of 6.54 -24.9 cc). The average volume of the post-surgical cavity contoured by the radiation oncologists on the planning CT was 15.71 (± 7.49 cc, range of 6.53 -24.31 cc). There was no noticeable change in volume size between post-operative/interim MRI and planning CT up to the period of 15 days. LIMITATION This was a retrospective pilot study with a small sample size and patients recruited from a single center. CONCLUSION There is no change in size of the cavity volume for up to 15 days between post-operative/interim MRI and planning CT. This knowledge will help understand the optimal time interval between post-operative MRI and CT simulation for the stereotactic radiation therapy planning.