Streamlining interdisciplinary communication to improve suspected acute stroke assessment, diagnosis and treatment times: Preliminary results for a smartphone communication app.

Abstract

Background and Aims: Rapid assessment, diagnosis and treatment for patients with acute stroke events requires communication between infield paramedics and multiple hospital clinicians (emergency, medical, neurology, radiology). Treatment delays may occur with information repeated between the interdisciplinary team from different organisations/hospital departments. Aim(s): To determine if a smartphone communication app can improve clinical care timelines for patients with suspected acute stroke. Method(s): Using a 12 month pre-post historical-control design, the PulsaraTM Stop Stroke/STEMI smartphone and tablet app (PulsaraTM) was implemented pre- (25 Ambulance Victoria branches) and within-hospital (2 hospitals in regional Victoria, Australia). PulsaraTM provides secure, simultaneous, two-way, real-time communication. Eligible patients had suspected acute stroke events assessed by paramedics or hospital clinicians. Pre-hospital and hospital assessment and treatment times were captured; data collection is ongoing. Preliminary results compare stroke care timelines if PulsaraTM was initiated (PulsaraTM) or not (no PulsaraTM) (hospital 1: 22/08/2016-21/02/2017; hospitals 1 and 2: 29/05/2017-31/ 10/2017). Result(s): There were 262 patients (no PulsaraTM/PulsaraTM: n=81/ n=185, both median 75 years, 52%/48% male) with PulsaraTM initiated by paramedics (n=115) and Emergency Departments (n=70). Faster paramedic hospital-arrival-to-departure by median 10 minutes (no PulsaraTM: 55 minutes [IQR: 43-64]; PulsaraTM 45 minutes [IQR: 35- 55]). Faster emergency department door-to-first medical review time by median 18 minutes (no PulsaraTM: 23 minutes [IQR: 6-65]; PulsaraTM 5 minutes [IQR: 1-11]) and faster door-to-CT completed by median 51 minutes (no PulsaraTM: 81 minutes [IQR: 39-145]; PulsaraTM: 27 minutes [IQR: 17-42]). All thrombolysis cases used PulsaraTM (n=38). Conclusion(s): Preliminary evidence supports improved care timelines. PulsaraTM was successfully implemented for the first time outside of America.