Improving Telestroke Treatment Times in an Expanding Network of Hospitals

Sanders, Keith A.; Patel, Rahul A.; Kiely, James M.; Gwynn, Matthews W.; Johnston, Lisa H.

doi:10.1016/j.jstrokecerebrovasdis.2015.09.030

Cited by 36 publications

(27 citation statements)

References 6 publications

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“…12–16 Hall and McGraw argue that these issues can be addressed with the development of a comprehensive regulatory framework for telemedicine overseen and enforced by the Federal Trade Commission. 16 Telemedical tools have been successfully implemented in acute stroke care 17–19 and ST-elevation myocardial infarction, 20–22 and those fields can provide a rubric for paradigms in neurosurgery.…”

Section: Discussionmentioning

confidence: 99%

Identification and Cost of Potentially Avoidable Transfers to a Tertiary Care Neurosurgery Service

et al. 2016

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Background Thousands of neurosurgical emergencies are transferred yearly to tertiary care facilities to assume a higher level of care. Several studies have examined how neurosurgical transfers influence patient outcomes, but characteristics of potentially avoidable transfers have yet to be investigated. Objective To identify whether potentially avoidable transfers represent a significant portion of transfers to a tertiary neurosurgical facility. Methods In this cohort study, we evaluated 916 neurosurgical patients transferred to a tertiary care facility over a 2-year period. Transfers were classified as potentially avoidable when no neurosurgical diagnostic test, intervention, or intensive monitoring was deemed necessary (n=180). The remaining transfers were classified as justifiable (n=736). The main outcomes and measures were age, sex, diagnosis, insurance status, intervention, distance of transfer, length of hospital and intensive care unit (ICU) stay, mortality, discharge disposition, and cost. Results Nearly 20% of transfers were identified as being potentially avoidable. While some of these patients had suffered devastating, irrecoverable neurologic insults, many had innocuous conditions that did not require transfer to a higher level of care. Justifiable transfers tend to involve patients with non-traumatic intracranial hemorrhage and cranial neoplasm. Both groups were admitted to the intensive care unit at the same rate (approximately 70% of patients). Finally, the direct transportation cost of potentially avoidable transfers was $1.46 million over 2 years. Conclusion This study identified frequency and expense of potentially avoidable transfers. There is a need for closer examination of the clinical and financial implications of potentially avoidable transfers.

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Section: Discussionmentioning

confidence: 99%

Identification and Cost of Potentially Avoidable Transfers to a Tertiary Care Neurosurgery Service

et al. 2016

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“…Studies have shown that telemedical consultation with a stroke neurologist remotely can reduce DTN times substantially at small hospitals 37 . While the DTN times are higher than the Helsinki protocol, transport to the nearest hospital is faster than to the "hub" hospital, potentially resulting in similar onset-to-treatment times 38 .…”

Section: Improving Stroke Systems Of Carementioning

confidence: 98%

Recent advances in the management of acute ischemic stroke

Chang

2017

F1000Res

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In recent years, several landmark trials have transformed acute ischemic stroke care. The most dramatic results from the field of acute endovascular intervention demonstrate unequivocal benefit for a select group of patients with moderate to severe deficits presenting within 7 hours from onset and with occlusions of proximal arteries in the anterior circulation. In addition, technological advances and workflow efficiencies have facilitated more rapid delivery of acute stroke interventions. This review provides an overview of recent advances in the management of acute ischemic stroke.

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“…In Germany, during the last two decades telemedical networks have been established including academic and community hospitals in sparselypopulated regions [21]. While positive impacts have been demonstrated [22,23], most reports, however, focus on one specific issue, such as the reliable determination of the NIHSS score [24], a timely access to computer tomography [25] or to intravenous thrombolysis [9,[26][27][28][29][30].…”

Section: Telemedical Networkmentioning

confidence: 99%

Two years’ experience of implementing a comprehensive telemedical stroke network comprising in mainly rural region: the Transregional Network for Stroke Intervention with Telemedicine (TRANSIT-Stroke)

Gabriel

Jiru-Hillmann

Kraft³

et al. 2020

BMC Neurol

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Background: Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years' experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region. Methods: The TRANSIT-Stroke network covers a mainly rural region in northwestern Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I-and level-II/III-hospitals. Results: Overall, 7881 patients were included (mean age 74.6 years ±12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period. Conclusion: The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.

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Improving Telestroke Treatment Times in an Expanding Network of Hospitals

Abstract: This study shows that a practice-based telemedicine system can produce meaningful improvement in markers of telestroke efficiency in the face of rapid growth of a telestroke network.

Cited by 36 publications

References 6 publications

Identification and Cost of Potentially Avoidable Transfers to a Tertiary Care Neurosurgery Service

Identification and Cost of Potentially Avoidable Transfers to a Tertiary Care Neurosurgery Service

Recent advances in the management of acute ischemic stroke

Two years’ experience of implementing a comprehensive telemedical stroke network comprising in mainly rural region: the Transregional Network for Stroke Intervention with Telemedicine (TRANSIT-Stroke)

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