Impact and implementation of a sustainable regional telestroke network

Ranta, Annemarei; Lanford, Jeremy; Busch, Suzanne; Providence, C.; Iniesta, Iván; Rosemergy, Ian; Wilson, Andrew; Cariga, Pietro; Richmond, Victoria L.; Gommans, John

doi:10.1111/imj.13557

Cited by 19 publications

(20 citation statements)

References 5 publications

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“…3,4 Improvement initiatives have included regular audit and review, service model changes to reduce treatment delays, public FAST campaigns to improve community stroke recognition, and the introduction of telestroke in several parts of the country to reduce geographic inequities. 5,6 This article reports on the 2018 New Zealand reperfusion therapy rates, explores the impact of service improvements on temporal trends and geographic variations, and identifies areas requiring further attention to achieve best patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…National and regional efforts have contributed to increased treatment rates and reduced treatment delays 3,4 . Improvement initiatives have included regular audit and review, service model changes to reduce treatment delays, public FAST campaigns to improve community stroke recognition, and the introduction of telestroke in several parts of the country to reduce geographic inequities 5,6 …”

Section: Introductionmentioning

confidence: 99%

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Trends in stroke reperfusion treatment and outcomes in New Zealand

Hedlund

Leighs

Barber

et al. 2020

Internal Medicine Journal

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Background: Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) can help reverse stroke symptoms in selected patients but are both time sensitive interventions. Aims: To report current stroke reperfusion rates and quality measures as well as trends over time in New Zealand. Method: Since 2015 New Zealand treatment centres have been mandated to enter prospectively all IVT and EVT patients into a low-cost National Stroke Register. Data were cleaned, and missing data added where possible through contact with individual hospitals. Main outcomes include treatment delays, vital status at day 7 and complications. Results: In 2018, there were 719 of 7173 (10.0%) patients with ischaemic stroke or stroke unspecified treated with IVT, up from 389 of 5963 (6.5%) patients in 2015 (P < 0.001), with no change in day 7 mortality (P = 0.63) or sICH rate (P = 0.22). Median (interquartile range (IQR)) door-to-needle times decreased from 65 (47-89) min in 2017 to 59 (40-84) min in 2018 (P = 0.022), and patients treated within 60 min increased from 40 to 51% (P < 0.001). In 2018, there were 243 (3.4%) patients treated with EVT up from 134/6859 (1.9%) in 2017 (P < 0.0001), with no change in 7-day mortality (P = 0.39) or intracerebral haemorrhage (sICH) (P = 0.78). There was no significant change in onset-to-needle (P = 0.21), arrival-to-groin (P = 0.28) or onset-to-reperfusion time (P = 0.32). Conclusion: Stroke reperfusion rates in New Zealand are continuously rising with no associated increase in complications. More patients are being treated faster upon hospital arrival but there remains room for further improvement in reducing onset to treatment delays.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Trends in stroke reperfusion treatment and outcomes in New Zealand

Hedlund

Leighs

Barber

et al. 2020

Internal Medicine Journal

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“…Interestingly, this study also showed a significant benefit resulting from the more rapid virtual interaction between the patient and the doctor in the hub hospitals in the out-of-hours period. 85 All these data underline the role of modern networking, including telemedicine-based networking, for decreasing critical time delays and improving outcomes in treatment of acute stroke.…”

Section: Telestroke Networkmentioning

confidence: 99%

Review. Regional Networks in Acute Cardiac Care

Marton-Popovici

2017

Journal of Cardiovascular Emergencies

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STEMI nETworkSThe implementation of dedicated networks for urgent revascularization in patients with ST-elevation myocardial infarction (STEMI) have been proved to represent a lifesaving strategy and is currently the goal of many healthcare systems. 6-10In patients with acute myocardial infarction, survival depends largely on the amount of viable myocardium remaining after the infarction. 11-13 The recovery of myocardial tissue is the main goal of therapy in emergency settings and can be achieved by urgent revascularization. 14-16In order to be effective, reperfusion of an occluded coronary artery should be achieved in the first 12 hours after the onset of chest pain. 17 While many precious hours are lost by the patients who do not present in time to the specialized services, sustained organizational efforts have been made in order to shorten the time from presentation to revascularization. 18-22One of the first regional STEMI networks has been initiated in the USA in Minnesota, including referral hospitals located at a radius of 210 miles from the pPCI center.The geographic territory surrounding the pPCI center was

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“…5 Telestroke practices are increasingly considered mature, 6 having shown positive effects on various indicators of quality, including cost savings, access to care, e cacy, patient functional outcomes, and patient satisfaction. 5,7,8 In the United States, most telestroke programs use a hub-and spoke network model, where stroke specialists employed at a full-service hub facility are consulted by limited-service (often rural) spoke facilities. [9][10][11] Some programs serve entire states or multistate regions (e.g., The University of Utah Health's Stroke Center accepts referrals from Utah and six surrounding states).…”

Section: Introductionmentioning

confidence: 99%

Building Cohesion in Distributed Telemedicine Teams Findings from the Department of Veterans Affairs National Telestroke Program

Patel

Damush

Miech

et al. 2020

Preprint

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Background: As telemedicine adoption increases, so does the importance of building cohesion among physicians in telemedicine teams. For example, in acute telestroke services, stroke specialists provide rapid virtual stroke assessment and treatment to patients at hospitals without stroke specialty care. In the National Telestroke Program (NTSP) of the U.S. Department of Veterans Affairs, a virtual (distributed) hub of stroke specialists throughout the country provides 24/7 consultations nationwide. We examined how these specialists adapted to distributed teamwork, and we identified cohesion-related factors in program development and support. Methods: We conducted a case study of the stroke specialists employed by the NTSP. Semi-structured, confidential interviews with stroke specialists in the virtual hub were recorded and transcribed. We explored the extent to which these specialists had developed a sense of shared identity and team cohesion, and we identified factors in this development. Using a qualitative approach with constant comparison methods, two researchers coded each interview transcript independently using a shared codebook. We used matrix displays to identify themes, with special attention to team cohesion, communication, trust, and satisfaction. Results: Of 13 specialists with at least 8 months of NTSP practice, 12 completed interviews; 7 had previously practiced in telestroke programs in other healthcare systems. Interviewees reported high levels of trust and team cohesion, sometimes even more with their virtual colleagues than with local colleagues. Factors facilitating perceived team cohesion included a weekly case conference call, a sense of transparency in discussing challenges, engagement in NTSP development tasks, and support from the NTSP leadership. Although lack of in-person contact was associated with lower cohesion, annual in-person NTSP meetings helped mitigate this issue. Despite technical challenges in establishing a new telehealth system within existing national infrastructure, providers reported high levels of satisfaction with the NTSP. Conclusion: A virtual telestroke hub can provide a sense of team cohesion among stroke specialists at a level comparable with a standard co-located practice. Engaging in transparent discussion of challenging cases, reviewing new clinical evidence, and contributing to program improvements may promote cohesion in distributed telemedicine teams.

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Impact and implementation of a sustainable regional telestroke network

Cited by 19 publications

References 5 publications

Trends in stroke reperfusion treatment and outcomes in New Zealand

Trends in stroke reperfusion treatment and outcomes in New Zealand

Review. Regional Networks in Acute Cardiac Care

Building Cohesion in Distributed Telemedicine Teams Findings from the Department of Veterans Affairs National Telestroke Program

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