Improving treatment times for acute stroke with a single communication system for interdisciplinary care: final results from implementing a smartphone app.

Abstract

Background and Aims: Delivery of acute stroke care relies on clinicians communicating clinical information efficiently. Varied communication methods are used between paramedics and hospital clinicians (emergency, medical, neurology, radiology). Details are often repeated, contributing to delays. The aim is to determine if a digital communication app can improve care timelines for patients with suspected acute stroke. Methods: A 12-month pre-post design was used. The PulsaraTM Stop Stroke/STEMI communication app was implemented pre-hospital (25 Ambulance Victoria branches) and within-hospital (2 rural hospitals) in Victoria, Australia. Pulsara provides secure, simultaneous, two-way, realtime communication. Eligible patients with suspected acute stroke assessed by paramedics or ED clinicians. Pre-hospital and hospital assessment/treatment times were recorded between August 2016 and August 2018. Median minutes (IQRS) were compared between two groups: Pulsara initiated (Pulsara), or not initiated (no Pulsara). Results: The no Pulsara (n ¼ 213) and Pulsara (n ¼ 391) groups were of similar age and sex (76 vs 75 years; 50% male). Pulsara was initiated by paramedics (n ¼ 223) and ED (n ¼ 168) clinicians. Patients were off ambulance stretchers faster by 8 minutes (no Pulsara: 19 minutes [11–29]; Pulsara 11 minutes [7–17]; p ¼.0001). Emergency department door-tofirst medical review was faster by 17 minutes (no Pulsara: 23 minutes [8–67]; Pulsara 6 minutes [2–14]; p ¼.0004). Door-to-CT times were 44 minutes faster (no Pulsara: 71 minutes [43–147]; Pulsara: 27 minutes [18–44]; p ¼.0001). Pulsara was used in 96% (52/54) of tPA cases. The proportion of patients with door-to-needle times < 60 minutes was 12% pre-Pulsara, compared to 26% with-Pulsara. Conclusions: Using a digital communication app improves acute stroke treatment times.