Abstract
Background: Because of the time-sensitive nature of stroke treatment, extensive efforts focus on reducing treatment time in the hospital and prehospital setting. Recent studies exploring the use of telemedicine within the ambulance setting report positive results. Non-recordable paramedic-assisted videos allowed patients to be examined by an ED physician while in route to the receiving hospital, improving stroke treatment times. Ambulance teleconsultations are reported to be reliable and a good method to aide emergency triage facilitating accurate diagnosis. To the best of our knowledge, these studies have used EMS tele-health services to connect with a physician. In this study we assessed the treatment benefits of a nurse-driven pre-hospital telemedicine program in a community comprehensive stroke center (CSC). Methods: Telemedicine services was installed in 4 ambulance units. A tablet was supplied to highly specialized stroke nurses. Using the current dispatch notification system, the stroke nurse was alerted to an incoming suspected stroke patient and prepared to receive the telemedicine video connection. During the telemedicine video call a paramedic-assisted assessment occurred, patient history, contact information, and pre-thrombolytic consent was obtained. Upon arrival, the stroke alert proceeded as normal. Telemedicine data was retrospectively matched with data extracted from the medical record to evaluate treatment volume (thrombolytics (TNK), endovascular procedure (EP), or both), treatment times [door to CT(D2CT), door to needle (D2N), door to puncture(D2P), door to device(D2D)], and coded stroke volume for all EMS-telemedicine cases between Jan 2020-May 2022. Results: Over the course of the pilot, 41 cases were successfully matched, and pre-hospital video assessments occurred for 17 (41%) cases. Treatment rates were 20% (n=8), 15% (n=6), and 10% (n=4) for TNK, EP, and both respectfully. Median times were 7 min (4-21), 20min (12-32), 58min (48-124), and 82 min (64-140) for D2CT, D2N, D2P, D2D respectively. Lastly, 71% (n=29) received a stroke diagnosis. Conclusion: This study shows that a nurse-driven prehospital telemedicine system can be successfully implemented in a community CRC with excellent treatment time metrics.
Published Version
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