Mobile Real-time Tracking of Acute Stroke Patients and Instant, Secure Inter-team Communication - the Join App

Munich, Stephan A; Tan, Lee A.; Nogueira, Danilo M; Keigher, Kiffon M; Chen, Michael; Crowley, R. Webster; Conners, James; Lopes, Demetrius K.

doi:10.5469/neuroint.2017.12.2.69

Cited by 36 publications

(28 citation statements)

References 13 publications

(14 reference statements)

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“…Several applications for AIS care have been developed earlier. These applications are excellent for image and text information sharing, but they do not have a multitask progress management function (13–18). Unlike these applications, TCS has been developed to support the management of tasks in AIS care.…”

Section: Discussionmentioning

confidence: 99%

A Visual Task Management Application for Acute Ischemic Stroke Care

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

A Visual Task Management Application for Acute Ischemic Stroke Care

et al. 2019

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“…2) The objectives of their use vary among applications, including triage and tracing of transport of acutely ill or injured patients, transmission of messages at the time of disaster, patient education for secondary prevention, and search of guidelines and literature, and the introduction of applications usable in team medical care for stroke is also underway. 1,3,4) Join is an application for communication among medical workers approved by pharmaceutical affairs authorities incorporating security measures against tapping and falsification in compliance with Japanese guidelines. It has been adopted by approximately 300 facilities in Japan at present and is also spreading to institutions in Western countries.…”

Section: Discussionmentioning

confidence: 99%

“…According to a questionnaire survey by Munich et al, for example, after the introduction of Join, the medical workers had generally favorable impressions of the application, with 87.5% of the respondents reporting good operability of the application and 82.5% recommending its continued use. 1) It is widely recognized that shortening the time from onset to the initiation of treatment is important for improving the outcome of acute cerebral infarction, and there have been reports about the effects of the introduction of the application on shortening the time. 5,6) Alotaibi et al 7) evaluated the effects of the smartphone application SunnyStroke, which promotes prompt chatting within the stroke team, on thrombectomy, and reported that the time from CT imaging to arterial puncture was significantly shortened from 127 minutes before to 69 minutes after its introduction.…”

Section: Discussionmentioning

confidence: 99%

Practical Use of a Communication Application on Mobile Devices by Our Stroke Team

Tokunaga

Inoue

Suruga

et al. 2020

JNET

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To describe our 1-year experience of the practical use of a mobile communication application by our stroke team. Methods: The mobile Join application (Allm Inc., Tokyo, Japan) was introduced into our stroke team for the purpose of immediate sharing of the patient information. We analyzed the usage situation for 1 year after the introduction of Join, particularly its efficacy in improving the door-to-puncture time (D2P) for thrombectomy cases, and reported our interhospital collaboration with the use of Join. Results: The total number of events notified by Join was 337, and they included acute stroke potentially leading to reperfusion therapy in 23% (76 events), head trauma in 14%, brain hemorrhage in 12%, other infarction in 10%, subarachnoid hemorrhage in 8%, and the others in 34%. The information of the patients was shared among the team members before arrival to our hospital in 42% of acute stroke cases. Of 31 patients undergoing mechanical thrombectomy, the median interval between arrival and groin puncture for the directly transported patients with/without pre-hospital information was 77.5 min/87 min, respectively, whereas that of the patients transferred from primary hospitals with/without pre-hospital information was 19 min/71 min (p <0.0001), respectively, demonstrating the efficacy of information sharing in advance through Join in improving the timing of endovascular therapy. For inter-hospital collaboration using the telestroke system, we concluded the partnership agreement with three local primary hospitals by communication via Join at a reasonable cost. Conclusion: Active and effective utilization of the mobile Join application for communication by our stroke team was demonstrated, and it is expected to promote inter-hospital collaboration in stroke treatment. Keywords▶ mechanical thrombectomy, medical informatics, mobile smartphone application, stroke team, telemedicine for the diagnosis and treatment of stroke, but there have been few reports on their actual state of utilization. Join (Allm Inc., Tokyo) is a communication application for medical workers approved by the pharmaceutical affairs regulatory authorities as a program for generalpurpose diagnostic imaging, the security of which is guaranteed by conforming to guidelines proposed by related ministries and agencies. 1) Join makes it possible to have chats within a team using mobile devices and view anonymized DICOM images in the hospital PACS, as well as to share information with other facilities that have adopted Join via a special server. In April 2018, our hospital was the first in the prefecture to install Join for prompt sharing of information among members of the Brain Disease Center, consisting of neurosurgeons and neurologists, and initiation of treatment, relieving the burden on on-call doctors in the stroke care unit, in addition to consultation with orthopedists/radiologists on standby outside the hospital from This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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“…The use of mobile applications during delivery of acute stroke care is well-known in stroke literature. The Join application (Allm, Inc, Tokyo, Japan) and Stop Stroke (Pulsara, Montana, U.S.) are two of the several existing communication applications to enhance the coordination and communication in delivery of acute stroke management (12, 13). Table 2 outlines the features that are offered by Code Stroke Alert, Join application, and Stop Stroke.…”

Section: Discussionmentioning

confidence: 99%

CODE STROKE ALERT—Concept and Development of a Novel Open-Source Platform to Streamline Acute Stroke Management

Seah

Burney²,

Phan

et al. 2019

Front. Neurol.

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Introduction: Effective, time-critical intervention in acute stroke is crucial to mitigate mortality rate and morbidity, but delivery of reperfusion treatments is often hampered by pre-, in-, or inter-hospital system level delays. Disjointed, repetitive, and inefficient communication is a consistent contributor to avoidable treatment delay. In the era of rapid reperfusion therapy for ischemic stroke, there is a need for a communication system to synchronize the flow of clinical information across the entire stroke journey. Material/Methods: A multi-disciplinary development team designed an electronic communications platform, integrated between web browsers and a mobile application, to link all relevant members of the stroke treatment pathway. The platform uses tiered notifications, geotagging, incorporates multiple clinical score calculators, and is compliant with security regulations. The system safely saves relevant information for audit and research. Results: Code Stroke Alert is a platform that can be accessed by emergency medical services (EMS) and hospital staff, coordinating the flow of information during acute stroke care, reducing duplication, and error in clinical information handover. Electronic data logs provide an auditable trail of relevant quality improvement metrics, facilitating quality improvement, and research. Discussion: Code Stroke Alert will be freely available to health networks globally. The open-source nature of the software offers valuable potential for future development of plug-ins and add-ons, based on individual institutional needs. Prospective, multi-site implementation, and measurement of clinical impact are underway.

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Mobile Real-time Tracking of Acute Stroke Patients and Instant, Secure Inter-team Communication - the Join App

Cited by 36 publications

References 13 publications

A Visual Task Management Application for Acute Ischemic Stroke Care

A Visual Task Management Application for Acute Ischemic Stroke Care

Practical Use of a Communication Application on Mobile Devices by Our Stroke Team

CODE STROKE ALERT—Concept and Development of a Novel Open-Source Platform to Streamline Acute Stroke Management

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