Improved assessment, diagnosis and treatment times for acute stroke: Interim results from the Pulsara smartphone communication app.

Abstract

Background: Rapid delivery of acute stroke care relies on interdisciplinary communication including between in-field paramedics and multiple hospital clinicians (emergency, medical, neurology, radiology). Assessment, diagnosis and treatment delays may occur with various communication systems and clinical information repeated between the different organisations/hospital departments.

Aim: To determine if a smartphone communication app can improve clinical care timelines for patients with suspected acute stroke.

Method: The PulsaraTM Stop Stroke/STEMI smartphone and tablet app (Pulsara) was implemented pre- (25 Ambulance Victoria branches) and within-hospital (2 hospitals in regional Victoria, Australia). Pulsara provides secure, simultaneous, two-way, real-time communication. Using a 12 month pre-post historical-control design, pre-hospital and hospital assessment and treatment times for patients with suspected acute stroke were captured; data collection is ongoing. Preliminary results compare timelines if Pulsara was initiated (Pulsara) or not (no Pulsara) (hospital 1: 22/08/2016-21/02/2017; hospitals 1 and 2: 29/05/2017-31/10/2017).

Results: Similar samples (no Pulsara/Pulsara: n¼81/n¼185, both median 75 years, 52%/48% male) with Pulsara initiated by paramedics (n¼115) and Emergency Departments (n¼70). Faster paramedic hospital-arrival-to-departure by median 10 minutes (no Pulsara: 55 minutes [IQR:43–64]; Pulsara 45 minutes [IQR: 35–55]). Faster emergency department door-to-first-medical-review time by median 18 minutes (no Pulsara: 23 minutes [IQR: 6–65]; Pulsara 5 minutes [IQR: 1–11]) and faster door-to-CT completed by median 51 minutes (no Pulsara: 81 minutes [IQR: 39–145]; Pulsara: 27 minutes [IQR: 17–42]). All thrombolysis cases used Pulsara (n¼38).

Conclusion: Results show consistent improvements in timelines when Pulsara is activated. This is the first time Pulsara has been successfully implemented outside of America.