Impact of a telemedicine system on acute stroke care in a community hospital

Pedragosa, Àngels; Alvarez-Sabin, José; Molina, Carlos A.; Sanclemente, Carmen; Martín, M.C.; Alonso, F.; Ribó, Marc

doi:10.1258/jtt.2009.090102

Cited by 44 publications

(33 citation statements)

References 23 publications

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“…15 During the 10 years, onset-to-treatment times and door-to-needle times decreased remarkably. Eighty percent of all IVT in the TEMPiS Stroke Units are delivered within 60 minutes of admission, thus being clearly beyond the target of the American Stroke Association of 50%.…”

Section: Discussionmentioning

confidence: 99%

TeleStroke Units Serving as a Model of Care in Rural Areas

Müller-Barna

Hubert

Boy

et al. 2014

Stroke

111

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Background and Purpose— Stroke Unit care improves stroke prognosis and is recommended for all patients with stroke. In rural areas, population-wide implementation of Stroke Units is challenging. Therefore, the TeleMedical Project for integrative Stroke Care (TEMPiS) was established in 2003 as a TeleStroke Unit network to overcome this barrier in Southeast Bavaria/Germany. Evaluation of its implementation between 2003 and 2005 had revealed improved process quality and clinical outcomes compared with matched hospitals without TeleStroke Units. Data on sustainability of these effects are lacking. Methods— Effects on the stroke care of the local population were analyzed by using data from official hospital reports. Prospective registries from 2003 to 2012 describe processes and outcomes of consecutive patients with stroke and transient ischemic attack treated in TEMPiS hospitals. Quality indicators assess diagnostics, treatment, and outcome. Rates and timeliness of intravenous thrombolysis as well as data on teleconsultations and secondary interhospital transfers were reported over time. Results— Within the covered area, network implementation increased the number of patients with stroke and transient ischemic attack treated in hospitals with (Tele-)Stroke Units substantially from 19% to 78%. Between February 2003 and December 2012, 54 804 strokes and transient ischemic attacks were treated in 15 regional hospitals, and 31 864 teleconsultations were performed. Intravenous thrombolysis was applied 3331 stroke cases with proportions increasing from 2.6% to 15.5% of all patients with ischemic stroke. Median onset-to-treatment times decreased from 150 (interquartile range, 127–163) to 120 minutes (interquartile range, 90–160) and door-to-needle times from 80 (interquartile range, 68–101) to 40 minutes (interquartile range, 29–59). Conclusions— TeleStroke Units can provide sustained high-quality stroke care in rural areas.

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Section: Discussionmentioning

confidence: 99%

TeleStroke Units Serving as a Model of Care in Rural Areas

Müller-Barna

Hubert

Boy

et al. 2014

Stroke

111

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“…Another trend analysis was conducted in Spain using baseline data for 201 cases in 2006 and 198 cases in 2007 after the activation of the telestroke program. 93 Telestroke consisted of videoconferencing between the patients at a community hospital and the stroke experts at a tertiary-care center. Specialists also had access to neuroimaging scans via the Picture Archiving and Communication System.…”

Section: The Search For Evidencementioning

confidence: 99%

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

Bashshur

Shannon

Smith

et al. 2014

Telemedicine and e-Health

274

210

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The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/readmissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.

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“…60,61 There are numerous reports and growing experience with telemedicine/telestroke being used successfully in many different healthcare settings (mostly hospital to hospital and physician to hospital links) to reduce time delays and increase the use of acute therapies in a timely manner. 60,[62][63][64][65][66][67][68][69][70][71][72][73][74] The ability to use an air ambulance transportation system may vary depending on local factors (ie, ability to land a helicopter). The use of telemedicine as a direct part of EMS transportation (ie, a link in the ambulance) is an emerging area with some technical and logistical challenges.…”

Section: Emergency Medical Servicesmentioning

confidence: 99%

Revised and Updated Recommendations for the Establishment of Primary Stroke Centers

Alberts

Latchaw

Jagoda

et al. 2011

Stroke

192

167

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for the Brain Attack CoalitionBackground and Purpose-The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. Methods-We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. Results-Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures. Conclusions-Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center. (Stroke. 2011;42:2651-2665.)

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Impact of a telemedicine system on acute stroke care in a community hospital

Cited by 44 publications

References 23 publications

TeleStroke Units Serving as a Model of Care in Rural Areas

TeleStroke Units Serving as a Model of Care in Rural Areas

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

Revised and Updated Recommendations for the Establishment of Primary Stroke Centers

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