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 in-field 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: To determine if a smartphone communication app can improve clinical care timelines for patients with suspected acute stroke.Method 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). Results 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 Preliminary evidence supports improved care timelines. PulsaraTM was successfully implemented for the first time outside of America. Trial registration number