E mergency Medical Services (EMS) field triage to stroke centers has gained considerable complexity because the demonstration of clinical benefit of endovascular treatment (ET) in recent randomized clinical trials.1 As a result, it has become critical to develop objective prehospital triage criteria that appropriately identify patients who are most likely to benefit from services only available at Comprehensive Stroke Centers (CSCs) and therefore require direct transportation, while also facilitating the proper triage of less complex or lower acuity patients to the nearest stroke center (CSCs, Primary Stroke Centers [PSCs], or Acute Stroke Ready Hospitals [ASRHs]). Proper selection of the destination stroke center will enhance appropriate resource use to meet the needs of individual patients to optimize time to reperfusion and the broader communities by minimizing the time an ambulance is unnecessarily out of service, and will more homogenously distribute patients with stroke to minimize the effects of crowding on a single healthcare system. Although field identification of potential candidates for mechanical thrombectomy is possible using stroke scales designed to recognize large vessel occlusion strokes (LVOS), 2-6 the decision tree is substantially more complex because many of these patients are also candidates for intravenous thrombolysis (IVT), which could often be more promptly provided at a closer location. Therefore, an optimal destination triage algorithm should not only include the probability of LVOS but also include information about Background and Purpose-The Emergency Medical Services field triage to stroke centers has gained considerable complexity with the recent demonstration of clinical benefit of endovascular treatment for acute ischemic stroke. We sought to describe a new smartphone freeware application designed to assist Emergency Medical Services professionals with the field assessment and destination triage of patients with acute ischemic stroke. Methods-Review of the application's platform and its development as well as the different variables, assessments, algorithms, and assumptions involved. Results-The FAST-ED (Field Assessment Stroke Triage for Emergency Destination) application is based on a built-in automated decision-making algorithm that relies on (1) a brief series of questions assessing patient's age, anticoagulant usage, time last known normal, motor weakness, gaze deviation, aphasia, and hemineglect; (2) a database of all regional stroke centers according to their capability to provide endovascular treatment; and (3) Global Positioning System technology with real-time traffic information to compute the patient's eligibility for intravenous tissue-type plasminogen activator or endovascular treatment as well as the distances/transportation times to the different neighboring stroke centers in order to assist Emergency Medical Services professionals with the decision about the most suitable destination for any given patient with acute ischemic stroke. Conclusions-The FAST-ED smar...

Background Information communication technology (ICT) is crucial to modern communication and information sharing. Effective interprofessional collaboration is essential in the care of elderly people. However, little is known about the effects of ICT on care provision for elderly people in a home setting. This retrospective cohort study examines the impact of interprofessional collaboration using ICT on the health outcomes of elderly home care patients. Methods The Team® mobile application promotes cooperation in local medical health care. It enables providers to obtain and share patient information within a single, cloud‐based platform. We collected and analyzed data from 554 patients from Nagaoka (Niigata prefecture, Japan) who received home care services from 2015 to 2020. We calculated the cumulative hazard ratio (HR) of death or admission to a hospital or nursing home for patients whose information was shared among different professions using the platform, and for those whose information was not shared. We used a Cox proportional hazards model, adjusted for covariates, and applied propensity score matching. Results The average age of the study population was 83.5 years; the median follow‐up period was 579.0 days. The risk of death or admission to a hospital or nursing home significantly decreased in the information‐shared group, compared with the control group (adjusted HR: 0.47 [p < 0.01]). Significance remained after propensity score matching (HR: 0.58; p = 0.01). Conclusions Interprofessional collaboration using ICT may reduce the risk of death or admission to a hospital or nursing home among elderly home care patients in Japan.

Since smartphone applications are revolutionizing telemedicine, a new application specifically for stroke care (JOIN) was designed. Addition of the JOIN smartphone application to the stroke treatment workflow in our hospital was assessed. JOIN has key functions that may improve the care of stroke patients, including the ability to (1) exchange information such as patient data and medical images in real-time throughout the entire process of patient management; (2) track each step of the protocol from door to discharge; and (3) facilitate real-time interaction of all team members via text, audio, and a video chat system. Two periods, 2.7 years before the implementation of JOIN (Pre-JOIN) with 37 patients and 2.2 years after (Post-JOIN) with 54 patients, were compared, and the workflow for all 91 patients who had a cerebral infarction and were treated with tissue plasminogen activator (tPA) and/or thrombectomy between October 2012 and July 2017 was reviewed. There were noticeable reductions in overall patient management time, including times for door-to-imaging, starting tPA treatment, and endovascular intervention with JOIN. Staff members were unanimously satisfied with JOIN, due to the increased efficiency of information exchange and the ability for real-time discussions with different professionals when needed. No significant changes in patient outcomes (as assessed by modified Rankin Scale [mRS] scores) at 3 months and in the total cost for the treatment were observed. A smartphone-based application with the capability of sharing information instantaneously among healthcare professionals facilitated time-sensitive, acute care of ischemic stroke patients.