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Title: Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care.
Author: Bladin, C.
Bagot, K.
Vu, M.
Kim, J.
Bernard, S.
Smith, K.
Hocking, G.
Coupland, T.
Pearce, Diane
Badcock, D.
Budge, M.
Nadurata, V.
Pearce, W.
Hall, H.
Kelly, Ben
Spencer, A.
Chapman, Pauline
Oqueli, Ernesto
Sahathevan, Ramesh
Kraemer, Thomas
Hair, Casey
Stub, D.
Cadilhac, D.
Issue Date: 2022
Publication Title: BMJ Open
Volume: 12
Issue: 7
Start Page: e052332
Abstract: Objectives To determine if a digital communication app improves care timelines for patients with suspected acute stroke/ST-elevation myocardial infarction (STEMI). Design Real-world feasibility study, quasi-experimental design. Setting Prehospital (25 Ambulance Victoria branches) and within-hospital (2 hospitals) in regional Victoria, Australia. Participants Paramedics or emergency department (ED) clinicians identified patients with suspected acute stroke (onset <4.5 hours; n=604) or STEMI (n=247). Intervention The Pulsara communication app provides secure, two-way, real-time communication. Assessment and treatment times were recorded for 12 months (May 2017–April 2018), with timelines compared between ‘Pulsara initiated’ (Pulsara) and ‘not initiated’ (no Pulsara). Primary outcome measure Door-to-treatment (needle for stroke, balloon for STEMI) Secondary outcome measures: ambulance and hospital processes. Results Stroke (no Pulsara n=215, Pulsara n=389) and STEMI (no Pulsara n=76, Pulsara n=171) groups were of similar age and sex (stroke: 76 vs 75 years; both groups 50% male; STEMI: 66 vs 63 years; 68% and 72% male). When Pulsara was used, patients were off ambulance stretcher faster for stroke (11(7, 17) vs 19(11, 29); p=0.0001) and STEMI (14(7, 23) vs 19(10, 32); p=0.0014). ED door-to-first medical review was faster (6(2, 14) vs 23(8, 67); p=0.0001) for stroke but only by 1 min for STEMI (3 (0, 7) vs 4 (0, 14); p=0.25). Door-to-CT times were 44 min faster (27(18, 44) vs 71(43, 147); p=0.0001) for stroke, and percutaneous intervention door-to-balloon times improved by 17 min, but non-significant (56 (34, 88) vs 73 (49, 110); p=0.41) for STEMI. There were improvements in the proportions of patients treated within 60 min for stroke (12%–26%, p=0.15) and 90 min for STEMI (50%–78%, p=0.20). Conclusions In this Australian-first study, uptake of the digital communication app was strong, patient-centred care timelines improved, although door-to-treatment times remained similar.
ISSN: ACCIDENT & EMERGENCY MEDICINE; CARDIOLOGY; Organisation of health services; Stroke.
Internal ID Number: 01923
Type: Journal Article
Appears in Collections:Research Output

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