Visualizing Acute Stroke Data to Improve Clinical Outcomes

Smith, Eric E.; Stephenson, Caroline J.; Choi, Philip; Goyal, Mayank; Hill, Michael D.

doi:10.1161/strokeaha.115.009517

Cited by 11 publications

(4 citation statements)

References 10 publications

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“…Real-time feedback of time metrics to the stroke team members is essential to improve the quality of acute stroke care (19). However, the feedback process is time-consuming, and many institutions avoid it when possible (20).…”

Section: Discussionmentioning

confidence: 99%

A Visual Task Management Application for Acute Ischemic Stroke Care

et al. 2019

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Background: To maximize the effect of intravenous (IV) thrombolysis and/or endovascular therapy (EVT) for acute ischemic stroke (AIS), stroke centers need to establish a parallel workflow on the basis of a code stroke (CS) protocol. At Kokura Memorial Hospital (KMH), we implemented a CS system in January 2014; however, the process of information sharing within the team has occasionally been burdensome.Objective: To solve this problem using information communication technology (ICT), we developed a novel application for smart devices, named “Task Calc. Stroke” (TCS), and aimed to investigate the impact of TCS on AIS care.Methods: TCS can visualize the real-time progress of crucial tasks for AIS on a dashboard by changing color indicators. From August 2015 to March 2017, we installed TCS at KMH and recommended its use during normal business hours (NBH). We compared the door-to-computed tomography time, the door-to-complete blood count (door-to-CBC) time, the door-to-needle for IV thrombolysis time, and the door-to-puncture for EVT time among three treatment groups, one using TCS (“TCS-based CS”), one not using TCS (“phone-based CS”), and one not based on CS (“non-CS”). A questionnaire survey regarding communication problems was conducted among the CS teams at 3 months after the implementation of TCS.Results: During the study period, 74 patients with AIS were transported to KMH within 4.5 h from onset during NBH, and 53 were treated using a CS approach (phone-based CS: 26, TSC-based CS: 27). The door-to-CBC time was significantly reduced in the TCS-based CS group compared to the phone-based CS group, from 31 to 19 min (p = 0.043). Other processing times were also reduced, albeit not significantly. The rate of IV thrombosis was higher in the TCS-based CS group (78% vs. 46%, p = 0.037). The questionnaire was correctly filled in by 34/38 (89%) respondents, and 82% of the respondents felt a reduction in communication burden by using the TCS application.Conclusions: TCS is a novel approach that uses ICT to support information sharing in a parallel CS workflow in AIS care. It shortens the processing times of critical tasks and lessens the communication burden among team members.

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Section: Discussionmentioning

confidence: 99%

A Visual Task Management Application for Acute Ischemic Stroke Care

et al. 2019

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“…3 Workflow and imaging data were analyzed weekly and frequent feedback provided to all sites through Web-based teleconferences. 5 The trial collected data on multiple events in the workflow from stroke symptom onset to reperfusion including time of stroke symptom onset, arrival in the emergency department of the endovascularcapable hospital, baseline imaging, randomization, intravenous tissue plasminogen activator (alteplase) administration, randomization, groin puncture, and reperfusion. Among patients who were referred to the endovascular-capable hospital from another hospital, data were collected on whether intravenous alteplase was administered before arrival in the emergency department of the endovascular-capable hospital (drip and ship) or after qualifying CT at the endovascularcapable hospital.…”

Section: Methodsmentioning

confidence: 99%

Analysis of Workflow and Time to Treatment on Thrombectomy Outcome in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) Randomized, Controlled Trial

et al. 2016

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Background— The Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial used innovative imaging and aggressive target time metrics to demonstrate the benefit of endovascular treatment in patients with acute ischemic stroke. We analyze the impact of time on clinical outcome and the effect of patient, hospital, and health system characteristics on workflow within the trial. Methods and Results— Relationship between outcome (modified Rankin Scale) and interval times was modeled by using logistic regression. Association between time intervals (stroke onset to arrival in endovascular-capable hospital, to qualifying computed tomography, to groin puncture, and to reperfusion) and patient, hospital, and health system characteristics were modeled by using negative binomial regression. Every 30-minute increase in computed tomography-to-reperfusion time reduced the probability of achieving a functionally independent outcome (90-day modified Rankin Scale 0–2) by 8.3% ( P =0.006). Symptom onset-to-imaging time was not associated with outcome ( P >0.05). Onset-to-endovascular hospital arrival time was 42% (34 minutes) longer among patients receiving intravenous alteplase at the referring hospital (drip and ship) versus direct transfer (mothership). Computed tomography-to-groin puncture time was 15% (8 minutes) shorter among patients presenting during work hours versus off hours, 41% (24 minutes) shorter in drip-ship patients versus mothership, and 43% (22 minutes) longer when general anesthesia was administered. The use of a balloon guide catheter during endovascular procedures shortened puncture-to-reperfusion time by 21% (8 minutes). Conclusions— Imaging-to-reperfusion time is a significant predictor of outcome in the ESCAPE trial. Inefficiencies in triaging, off-hour presentation, intravenous alteplase administration, use of general anesthesia, and endovascular techniques offer major opportunities for improvement in workflow. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01778335.

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“…Visualisation of data can also prompt the discovery of new information within it, which may result in changes to practice and improved educational and clinical outcomes (Gill et al 2015;Vaitsis et al 2014). The benefits of better understanding data can apply at both individual and population levels (Kamal et al 2015;Schneiderman et al 2013) and are as relevant to review articles as primary research (Bravata et al 2007). Recent work by four of the authors used novel visualisation of data to make systematic review findings more clearly understood (Figure 1).…”

Section: Tip 10: 'Consider the Choice Of Evidence Synthesis Carefully'mentioning

confidence: 99%

Twelve tips for undertaking a focused systematic review in medical education

et al. 2018

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The exponential growth of the systematic review methodology within health has been mirrored within health education, allowing large numbers of publications on a topic to be synthesised to guide researchers and teachers. The robust, transparent and reproducible search methodologies employed offer scholarly rigour. The scope and scale of many reviews in education have only been matched by the size of the commitment needed to complete them and occasional lack of utility of reports. As such, we have noticed a growth in reviews across journals in the field that have questions that are more focused in scope. The authors propose 12 tips for performing a focused review in the right settings for the right reasons and discuss why such 'focused reviews' may be more beneficial in those circumstances. Focused reviews allow researchers to formulate answers to specific local issues that have explicit utility of findings. Such reviews are equipped to identify what works for specific groups in specific circumstances and even question how and why this may occur. An additional impact of a focused approach can be a rapid turnaround. This article explains the purpose and benefits of focused review and provides guidance on how to produce them.

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Visualizing Acute Stroke Data to Improve Clinical Outcomes

Cited by 11 publications

References 10 publications

A Visual Task Management Application for Acute Ischemic Stroke Care

A Visual Task Management Application for Acute Ischemic Stroke Care

Analysis of Workflow and Time to Treatment on Thrombectomy Outcome in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) Randomized, Controlled Trial

Twelve tips for undertaking a focused systematic review in medical education

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