Development and Pilot Testing of 24/7 In-Ambulance Telemedicine for Acute Stroke: Prehospital Stroke Study at the Universitair Ziekenhuis Brussel-Project

Abstract

Background: In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study at the Universitair Ziekenhuis Brussel (PreSSUB) to facilitate a wider spread of the knowledge regarding this technique. Methods: Successful execution of the project involved the development and validation of a novel stroke scale, design and creation of specific hardware and software solutions, execution of field tests for mobile internet connectivity, design of new care processes and information flows, recurrent training of all professional caregivers involved in acute stroke management, extensive testing on healthy volunteers, organisation of a 24/7 teleconsultation service by trained stroke experts and 24/7 technical support, and resolution of several legal issues. Results: In all, it took 41 months of research and development to confirm the safety, technical feasibility, reliability, and user acceptance of the PreSSUB approach. Stroke-specific key information can be collected safely and reliably before and during ambulance transportation and can adequately be communicated with the inhospital team awaiting the patient. Conclusion: This paper portrays the key steps required and the lessons learned for successful implementation of a 24/7 expert telemedicine service supporting patients with acute stroke during ambulance transportation to the hospital.

Time Gain Needed for In-Ambulance Telemedicine: Cost-Utility Model

“…This is achieved by bringing the computed tomography (CT) scan to the patient, and time gains of 15 minutes between emergency call to IVT have been realized using this method [ 3 ]. In-ambulance telemedicine is another promising approach to reduce delays of the in-hospital stroke response by gathering and transferring relevant diagnostic information while the patient is underway to the hospital and therefore facilitating the clinical decision making on performing a CT scan and treatment initiation [ 4 ]. Recent progress in mobile connectivity enables virtually every ambulance to be equipped with telemedicine solutions, and several projects confirm the medical interest in this approach [ 4 - 8 ].…”

“…In-ambulance telemedicine is another promising approach to reduce delays of the in-hospital stroke response by gathering and transferring relevant diagnostic information while the patient is underway to the hospital and therefore facilitating the clinical decision making on performing a CT scan and treatment initiation [ 4 ]. Recent progress in mobile connectivity enables virtually every ambulance to be equipped with telemedicine solutions, and several projects confirm the medical interest in this approach [ 4 - 8 ]. In-ambulance telemedicine allows head-to-toe examination of each patient through bidirectional audio-video communication between the ambulance and a remote teleconsultant and the secure transfer of medical data during emergency transportation of patients to a care facility.…”

“…In-ambulance telemedicine allows head-to-toe examination of each patient through bidirectional audio-video communication between the ambulance and a remote teleconsultant and the secure transfer of medical data during emergency transportation of patients to a care facility. Pilot studies on stroke patients have shown that 24/7 in-ambulance telemedicine support is feasible, and stroke-specific information can be collected and communicated to the in-hospital team during emergency ambulance transportation [ 4 , 5 ]. The use of in-ambulance telemedicine is well accepted by patients and emergency personnel [ 5 , 9 ].…”

“…The use of in-ambulance telemedicine is well accepted by patients and emergency personnel [ 5 , 9 ]. The combination of prehospital triage, early notification of the receiving in-hospital team, and communication of stroke-specific information by a remote stroke expert while the patient is being transported to the hospital has the potential to speed up the stroke diagnosis and treatment [ 4 ]. A time gain of 20 minutes has the potential to improve the probability of a favorable outcome after intravenous thrombolysis by 2.3% in a mixed stroke population [ 10 ] and is associated with reduced in-hospital mortality, lower risk of symptomatic intracranial hemorrhage, increased chance of independency at discharge, and increased probability to be discharged home [ 11 ].…”

Editorial

“…In addition, in the last few years, concomitant diseases for stroke have become a major theme of discussion, for example, stroke and cancer [16] or stroke and kidney diseases [17,18]. Stroke researchers and clinicians have to deal with local health networks [19,20], in- and pre-hospital patient triages [21,22] and stroke patients have to be identified while they are being treated for other diseases [23]. Acute stroke treatment now predominantly includes the time in an intensive care unit and we published some interesting manuscripts about this aspect [24,25,26,27].…”