178 RUN-FC: network of neurological emergencies in Franche Comte

Abstract

Stroke is the leading cause of disability, the second leading cause of dementia and the third leading cause of death in France. Head injuries resulting from road accidents are also on the list of public health priorities defined by the Ministry of Health. The emeRgency neUrology Network in Franche-Comté (RUN-FC) is a regional structure, designed to meet the everyday needs of emergency neurology patients (stroke and head injuries) by combining the efforts of all those involved in patient care.Besançon University Hospital is the only hospital in the region to house a neurosurgery department and a specialist unit for neurovascular pathology. The RUN network has developed a range of telemedicine tools, enabling neurologists, neurosurgeons and radiologists at the university hospital to give medical advise to emergency physicians in 11 other hospitals in the Franche-Comté region where on-site specialists are not available.Image transfers (CT, MRI), videoconferencing and electronic patient medical records are the telemedicine tools which enable information to be exchanged in real time, improving the reliability and accuracy of the diagnosis. Telemedicine allows an accurate, standardised neurological examination to be performed remotely, and enables a diagnosis and therapeutic decision to be made. Furthermore, a neurologist from Besançon University Hospital visits the hospital in Pontarlier once a week. This special collaboration has enabled 44% more strokes and TIAs to be diagnosed.In parallel, the RUN network monitors stroke victims hospitalised in Besançon for five years following discharge. A nurse from the network reviews every electronic patient file, makes regular contact with every patient, listens, gives advice and suggests an appointment with a neurologist if a problem is detected. The patient's general practitioner is kept informed at all times.Between 2002 and 2008, 8000 images were transferred via the RUN-FC server. The use of telemedicine has reduced the number of patient transfers by 50%. These avoidable transfers have proven detrimental to the patient, or at best, costly and of little avail. During the first five years, an estimated 3.5 million euros were saved (in transport costs). Savings made over the following years have been even greater due to the large increase in the number of patients receiving on-site treatment via teleconsultation. Between 2003 and October 2009, 79 patients received thrombolytic treatment at Besançon University Hospital (35% of which after transfer), and 48 patients were thrombolysed in the peripheral hospitals. A retrospective study on 76 patients shows that, in the peripheral hospitals, the time delay before initiating thrombolysis is shorter, and the treatment at least as effective, as at the university hospital.Since 2003, 2600 stroke victims have been followed up within the network. 20% of patients have required action to be taken by the network at least once. The survival rate of discharged patients at 18 months, has risen from 87% between 1987 and 1994, to 94% between 200...