A Visual Task Management Application for Acute Ischemic Stroke Care.

Shoji Matsumoto,Yusuke Funakoshi,Kazutaka Sonoda,Konosuke Furuta,Wataru Takita,Akira Ishii,Taketo Hatano,Takuma Ishihara,Atsushi Tsujimoto,Ryo Yamasaki,Hiroshi Koyama,Eiji Higashi,Takuro Hashikawa,Izumi Nagata,Keisuke Tokunaga,Daisuke Kondo,Tsuyoshi Ohta,Mitsushige Ando,Junpei Koge,Takahiko Kamata,Sadayoshi Watanabe,Takako Torii,Kõji Tanaka ,Hiroyuki Nakagaki ,Ichirō Nakahara ,H Chihara ,Tsuyoshi Hashimoto ,Jun Ichi Kira

doi:10.3389/fneur.2019.01118

Abstract

Background: To maximize the effect of intravenous (IV) thrombolysis and/or endovascular therapy (EVT) for acute ischemic stroke (AIS), stroke centers need to establish a parallel workflow on the basis of a code stroke (CS) protocol. At Kokura Memorial Hospital (KMH), we implemented a CS system in January 2014; however, the process of information sharing within the team has occasionally been burdensome.Objective: To solve this problem using information communication technology (ICT), we developed a novel application for smart devices, named “Task Calc. Stroke” (TCS), and aimed to investigate the impact of TCS on AIS care.Methods: TCS can visualize the real-time progress of crucial tasks for AIS on a dashboard by changing color indicators. From August 2015 to March 2017, we installed TCS at KMH and recommended its use during normal business hours (NBH). We compared the door-to-computed tomography time, the door-to-complete blood count (door-to-CBC) time, the door-to-needle for IV thrombolysis time, and the door-to-puncture for EVT time among three treatment groups, one using TCS (“TCS-based CS”), one not using TCS (“phone-based CS”), and one not based on CS (“non-CS”). A questionnaire survey regarding communication problems was conducted among the CS teams at 3 months after the implementation of TCS.Results: During the study period, 74 patients with AIS were transported to KMH within 4.5 h from onset during NBH, and 53 were treated using a CS approach (phone-based CS: 26, TSC-based CS: 27). The door-to-CBC time was significantly reduced in the TCS-based CS group compared to the phone-based CS group, from 31 to 19 min (p = 0.043). Other processing times were also reduced, albeit not significantly. The rate of IV thrombosis was higher in the TCS-based CS group (78% vs. 46%, p = 0.037). The questionnaire was correctly filled in by 34/38 (89%) respondents, and 82% of the respondents felt a reduction in communication burden by using the TCS application.Conclusions: TCS is a novel approach that uses ICT to support information sharing in a parallel CS workflow in AIS care. It shortens the processing times of critical tasks and lessens the communication burden among team members.

Highlights

Administration of intravenous tissue plasminogen activator (IV-tPA) and/or endovascular therapy (EVT) is associated with improved outcomes in acute ischemic stroke (AIS) (1, 2)
We retrospectively reviewed the data from consecutive patients with AIS transported within 4.5 h of symptom onset and divided them into three groups: a group where the code stroke (CS) system was not activated (“non-CS”), a group where CS was used without TCS (“phone-based CS”), and a group where the CS system and the TCS application were used (“TCS-based CS”)
A total of 74/183 (40%) patients were transported during NBH, and 53/74 (72%) patients were treated based on the CS system (27 patients were treated with TCS, and the remaining 26 patients were treated without TCS)

Summary

Introduction

Administration of intravenous tissue plasminogen activator (IV-tPA) and/or endovascular therapy (EVT) is associated with improved outcomes in acute ischemic stroke (AIS) (1, 2). At Kokura Memorial Hospital (KMH), we have attempted to shorten DTN times since January 2014, by designating a professional team in the organizational structure and implementing a 24/7 CS system consisting of a pre-arrival notification and activation of the entire stroke team by phone, rapid laboratory testing, an uninterrupted supply of the IV-tPA tool kit, and continuous availability of computed tomography (CT) and magnetic resonance imaging (MRI). To maximize the effect of intravenous (IV) thrombolysis and/or endovascular therapy (EVT) for acute ischemic stroke (AIS), stroke centers need to establish a parallel workflow on the basis of a code stroke (CS) protocol. At Kokura Memorial Hospital (KMH), we implemented a CS system in January 2014; the process of information sharing within the team has occasionally been burdensome

Methods

Results

Conclusion