Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System

Nguyen‐Huynh, Mai N.; Klingman, Jeffrey; Avins, Andrew L.; Rao, V.; Eaton, Abigail; Bhopale, Sunil; Kim, Anne C.; Morehouse, John; Flint, Alexander C.

doi:10.1161/strokeaha.117.018413

Cited by 62 publications

(83 citation statements)

References 35 publications

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“…Hastaları ilk gören ve triajı sağlayan birinci basamak hekimlerinin trombolitik tedavinin uygulama zamanını doğru olarak bilmeleri morbidite ve mortalite üzerine etkisi olabilir. Günümüzde iskemik inme tedavisinde prognozu olumlu yönde etkileyecek en önemli parametre trombolitik tedavinin uygulama zamanı olup bu konuda arayışlar sürmektedir (8). Tedavi ne kadar erken uygulanırsa başarı şansı o kadar yüksek; komplikasyon oranı ise o kadar düşüktür.…”

Section: Discussionunclassified

Ischemic Stroke Awareness Among Primary Care Physicians

Yıldız¹

2018

BTDMJB

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Objective: Ischemic stroke is one of the most important causes of morbidity and mortality in our country. In this study, ischemic stroke awareness was investigated among physicians working in primary health care service by questionnaire method. Methods: One hundred and twenty six family physicians received a stroke awareness questionnaire consisting of 10 questions. Results: The average occupational experience of physicians was 16±13 years. Approximately 25% correct answers to the questions were found. Conclusion: Training meetings of ischemic stroke for physicians working in primary health care services should be done more frequently.

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Section: Discussionunclassified

Ischemic Stroke Awareness Among Primary Care Physicians

Yıldız¹

2018

BTDMJB

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“…In Germany, during the last two decades telemedical networks have been established including academic and community hospitals in sparselypopulated regions [21]. While positive impacts have been demonstrated [22,23], most reports, however, focus on one specific issue, such as the reliable determination of the NIHSS score [24], a timely access to computer tomography [25] or to intravenous thrombolysis [9,[26][27][28][29][30].…”

Section: Telemedical Networkmentioning

confidence: 99%

Two years’ experience of implementing a comprehensive telemedical stroke network comprising in mainly rural region: the Transregional Network for Stroke Intervention with Telemedicine (TRANSIT-Stroke)

Gabriel

Jiru-Hillmann

Kraft³

et al. 2020

BMC Neurol

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Background: Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years' experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region. Methods: The TRANSIT-Stroke network covers a mainly rural region in northwestern Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I-and level-II/III-hospitals. Results: Overall, 7881 patients were included (mean age 74.6 years ±12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period. Conclusion: The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.

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“…Among reports of virtual-hub networks providing specialty care services (e.g., 14,37 ), to our knowledge, this is the rst direct study of virtual clinical specialists' perspectives. Our ndings complement previous studies of other telestroke stakeholders about implementation and sustainability, mostly with the staff of spoke sites rather than the hub sites [38][39][40] and hospital and program administrators.…”

Section: Noveltymentioning

confidence: 99%

“…An alternative network model, the virtual hub (also known as networked, hubless, or distributed), requires no central facility. [12][13][14] Such hubs are increasingly common, especially in widely distributed healthcare systems (e.g., Victorian [AU] Stroke Telemedicine program, 15 Lancashire and Cumbria [GB] Telestroke Network, 16 Kaiser Permanente Northern California [US] Stroke EXPRESS 14 ). With virtual hub networks, universal access to stroke specialists is increasingly achievable.…”

Section: Introductionmentioning

confidence: 99%

Building Cohesion in Distributed Telemedicine Teams Findings from the Department of Veterans Affairs National Telestroke Program

Patel

Damush

Miech

et al. 2020

Preprint

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Background: As telemedicine adoption increases, so does the importance of building cohesion among physicians in telemedicine teams. For example, in acute telestroke services, stroke specialists provide rapid virtual stroke assessment and treatment to patients at hospitals without stroke specialty care. In the National Telestroke Program (NTSP) of the U.S. Department of Veterans Affairs, a virtual (distributed) hub of stroke specialists throughout the country provides 24/7 consultations nationwide. We examined how these specialists adapted to distributed teamwork, and we identified cohesion-related factors in program development and support. Methods: We conducted a case study of the stroke specialists employed by the NTSP. Semi-structured, confidential interviews with stroke specialists in the virtual hub were recorded and transcribed. We explored the extent to which these specialists had developed a sense of shared identity and team cohesion, and we identified factors in this development. Using a qualitative approach with constant comparison methods, two researchers coded each interview transcript independently using a shared codebook. We used matrix displays to identify themes, with special attention to team cohesion, communication, trust, and satisfaction. Results: Of 13 specialists with at least 8 months of NTSP practice, 12 completed interviews; 7 had previously practiced in telestroke programs in other healthcare systems. Interviewees reported high levels of trust and team cohesion, sometimes even more with their virtual colleagues than with local colleagues. Factors facilitating perceived team cohesion included a weekly case conference call, a sense of transparency in discussing challenges, engagement in NTSP development tasks, and support from the NTSP leadership. Although lack of in-person contact was associated with lower cohesion, annual in-person NTSP meetings helped mitigate this issue. Despite technical challenges in establishing a new telehealth system within existing national infrastructure, providers reported high levels of satisfaction with the NTSP. Conclusion: A virtual telestroke hub can provide a sense of team cohesion among stroke specialists at a level comparable with a standard co-located practice. Engaging in transparent discussion of challenging cases, reviewing new clinical evidence, and contributing to program improvements may promote cohesion in distributed telemedicine teams.

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Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System

Abstract: Supplemental Digital Content is available in the text.

Cited by 62 publications

References 35 publications

Ischemic Stroke Awareness Among Primary Care Physicians

Ischemic Stroke Awareness Among Primary Care Physicians

Two years’ experience of implementing a comprehensive telemedical stroke network comprising in mainly rural region: the Transregional Network for Stroke Intervention with Telemedicine (TRANSIT-Stroke)

Building Cohesion in Distributed Telemedicine Teams Findings from the Department of Veterans Affairs National Telestroke Program

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