In‐hospital acute stroke workflow in acute stroke – Systems‐based approaches

Bradley

Chattu

et al. 2020

Front. Public Health

Self Cite

216

198

Coronavirus disease 2019 (COVID-19) has accelerated the adoption of telemedicine globally. The current consortium critically examines the telemedicine frameworks, identifies gaps in its implementation and investigates the changes in telemedicine framework/s during COVID-19 across the globe. Streamlining of global public health preparedness framework that is interoperable and allow for collaboration and sharing of resources, in which telemedicine is an integral part of the public health response during outbreaks such as COVID-19, should be pursued. With adequate reinforcement, telemedicine has the potential to act as the "safety-net" of our public health response to an outbreak. Our focus on telemedicine must shift to the developing and under-developing nations, which carry a disproportionate burden of vulnerable communities who are at risk due to COVID-19.

Section: Language Barriers In Telemedicine In Lmicsmentioning

confidence: 99%

Telemedicine Across the Globe-Position Paper From the COVID-19 Pandemic Health System Resilience PROGRAM (REPROGRAM) International Consortium (Part 1)

Bradley

Chattu

et al. 2020

Front. Public Health

Self Cite

216

198

“…Furthermore, the synergistic effect of in-hospital and prehospital interventions was not explored. 12 Moreover, means and standard deviations needed to be estimated, albeit with a verified method. Finally, some meta-analyses did not include many studies and participants.…”

Section: M Itati O N Smentioning

confidence: 99%

“…Significant efforts have been put into optimizing the stroke workflow to minimize treatment delay in acute reperfusion therapy. 11,12 However, the prehospital setting remains a significant source of delay and an area in which workflow optimizations have been limited and where universal proven standards of care are lacking. Several studies on prehospital stroke workflow optimization (PSWO) have implemented varying strategies and shown success in reducing workflow time delay and patient treatment rates.…”

Section: Introductionmentioning

confidence: 99%

Effect of prehospital workflow optimization on treatment delays and clinical outcomes in acute ischemic stroke: A systematic review and meta‐analysis

Chowdhury

Baskar

Academic Emergency Medicine

2021

Self Cite

Background The prehospital phase is critical in ensuring that stroke treatment is delivered quickly and is a major source of time delay. This study sought to identify and examine prehospital stroke workflow optimizations (PSWOs) and their impact on improving health systems, reperfusion rates, treatment delays, and clinical outcomes. Methods The authors conducted a systematic literature review and meta‐analysis by extracting data from several research databases (PubMed, Cochrane, Medline, and Embase) published since 2005. We used appropriate key search terms to identify clinical studies concerning prehospital workflow optimization, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results The authors identified 27 articles that looked at the impact of prehospital workflow optimizations on time and treatment parameters; 26 were included in the meta‐analysis. The PSWO were subgrouped into three categories: improved intravenous thrombolysis (IVT) triage, large‐vessel occlusion (LVO) bypass, and mobile stroke unit (MSU). The salient findings are as follows: improved IVT triage led to significantly improved rates of IVT (relative risk [RR] = 1.80, 95% confidence interval [CI] = 1.18 to 2.75); however, MSU did not (RR = 1.22, 95% CI = 0.98 to 1.52). Improved IVT triage (standard mean difference [SMD] = –0.82, 95% CI = –1.32 to –0.32), LVO bypass (SMD = –0.80, 95% CI = –1.13 to –0.47), and MSU (SMD = –0.87, 95% CI = –1.57 to –0.17) were found to significantly reduce door‐to‐needle time for IVT. MSU was found to significantly reduce call‐to‐needle (SMD = –1.41, 95% CI = –1.94 to –0.88) and onset‐to‐needle (SMD = –1.15, 95% CI = –1.74 to –0.56) times for IVT. MSU additionally demonstrated significant reduction in door‐to‐perfusion (SMD = –0.72, 95% CI = –1.32 to –0.12) as well as call‐to‐perfusion (SMD = –0.73, 95% CI = –1.08 to –0.38) times for EVT. Finally, PSWO did not demonstrate significant improvements in rates of good functional outcome (RR = 1.04, 95% CI = 0.97 to 1.12) or mortality at 90 days (RR = 1.00, 95% CI = 0.76 to 1.31). Conclusions This systematic review and meta‐analysis found that PSWO significantly improves several time metrics related to stroke treatment leading to improvement in IVT reperfusion rates. Thus, the implementation of these measures in stroke networks is a promising avenue to improve an often‐neglected aspect of the stroke response. However, the limited available data suggest functional outcomes and mortality are not significantly improved by PSWO; hence, further studies and improvement strategies vis‐à‐vis PSWOs are warranted.

“…Due to cost-benefit and infrastructural reasons, as well as a shortage of neuro-interventionalists, not every spoke will have endovascular therapy capabilities. Additionally, barriers in access to health systems, applicable to culturally and linguistically diverse communities (CALD) as well as those from marginalized backgrounds or low resourced settings, merit special consideration (55,56).…”

Section: Telemedicine Organizational Frameworkmentioning

confidence: 99%

Designing Futuristic Telemedicine Using Artificial Intelligence and Robotics in the COVID-19 Era

Bradley

Sakhamuri

et al. 2020

Front. Public Health

Self Cite

102

Technological innovations such as artificial intelligence and robotics may be of potential use in telemedicine and in building capacity to respond to future pandemics beyond the current COVID-19 era. Our international consortium of interdisciplinary experts in clinical medicine, health policy, and telemedicine have identified gaps in uptake and implementation of telemedicine or telehealth across geographics and medical specialties. This paper discusses various artificial intelligence and robotics-assisted telemedicine or telehealth applications during COVID-19 and presents an alternative artificial intelligence assisted telemedicine framework to accelerate the rapid deployment of telemedicine and improve access to quality and cost-effective healthcare. We postulate that the artificial intelligence assisted telemedicine framework would be indispensable in creating futuristic and resilient health systems that can support communities amidst pandemics.