Improving the quality of stroke care in rural settings with digital health technologies: accessing acute stroke expertise and streamlining multidisciplinary communication.

Abstract

Background: Safe delivery of time-critical treatments to patients presenting with acute stroke requires swift interdisciplinary decision-making and stroke expertise. Hospitals in rural Australia have used telemedicine and a smartphone communication application to streamline communication and provide access to stroke neurologists.

Methods: The Victorian Stroke Telemedicine (VST) program (commenced 2010) provides 24/7 access to metropolitan-based neurologists for 16 rural hospitals. At two of these hospitals, the Pulsara™ Stop Stroke/STEMI smartphones/tablet app (Pulsara) was also implemented (commenced 2016). Pulsara provides patient information securely, in real-time, facilitating pre-notification and synchronised communication between in-field paramedics and hospital clinicians. A 12-month historical-controlled cohort design was used; preliminary results are presented.

Results: Compared to pre-VST (n = 2921), with VST (n = 3378) the proportion of patients with ischemic stroke arriving within 4.5 hours of symptom onset who received intravenous thrombolysis increased (from 30% pre-VST to 38% VST, p = 0.019) with 25% of these transferred for endovascular clot retrieval. The proportion of patients receiving thrombolysis within 60 minutes of arrival increased (from 14% pre-VST to 32% VST, p < 0.001), while the proportion with a symptomatic intracerebral hemorrhage after thrombolysis reduced (from 16% pre-VST to 5% VST, p = 0.002). When Pulsara was used (n = 2 large rural hospitals), door-to-CT times were faster (no Pulsara: 81 minutes [IQR: 39–145]; Pulsara: 27 minutes [IQR: 17–42]). Compared to the pre-Pulsara period, door-to-needle times were faster (pre-Pulsara: n = 22, 84 minutes [IQR: 74–111]; Pulsara: n = 38, 78 minutes [IQR: 61–101]).

Conclusion: Technology-driven innovation improved acute stroke care through facilitating access to stroke expertise and streamlining the interdisciplinary communication required.