Use of a Smartphone Application to Speed Up Interhospital Transfer of Acute Ischemic Stroke Patients for Thrombectomy

Abstract

Background: In most countries, large cerebral artery occlusion is identified as the leading cause of disability. In 2015, five large-scale clinical trials confirmed the benefit of intra-arterial thrombectomy. However, thrombectomy is a highly technical and facility-dependent procedure. Primary stroke centers need to transfer patients to comprehensive stroke centers to perform thrombectomy. The time-lapse during interhospital transfer would decrease the chance of the patient's proper recovery. Communication barriers also contribute to this delay.Aims: We used a smartphone application to overcome communication barriers between hospitals. We aimed to shorten the door-to-puncture time of interhospital transfer patients.Methods: We began using a smartphone application, “LINE,” to facilitate interhospital communication on May 01, 2018. We carried out retrospective data analyses for all the transfer patients (n = 351), with the primary outcome being the door-to-puncture time in our comprehensive stroke center (China Medical University Hospital). We compared the three periods: May 01 to Dec 31, 2017 (before the use of the smartphone application); May 01 to Dec 31, 2018 (the 1st year of using the smartphone application); and May 01 to Dec 31, 2019 (the 2nd year of using the smartphone application). We also compared the transfer data with non-transfer thrombectomies in the same period.Results: We compared 2017, 2018, and 2019 data. The total number of transfer patients increased over the years: 63, 113, 175, respectively. The mean door-to-puncture time decreased significantly, going from 109, through 102, to 92 min. Meanwhile, the mean door-to-puncture time in non-transfer patients were 140.3, 122.1, and 129.3 min. The main reason of time saving was the change of the way of communication, from point-to-point interhospital communication to hub-to-spoke interhospital communication.Conclusions: We used this smartphone application to enhance interhospital communication, changed from the point-to-point to hub-to-spoke method. It made us overcome the communication barrier and build up interhospital connection, thus shortening the door-to-puncture time. Our experience demonstrated the importance of close communication and teamwork in hyperacute stroke care, especially in interhospital transfer for thrombectomy.

A comparison of in-hospital stroke and community- onset stroke outcomes after endovascular thrombectomy at a tertiary level hospital in Taiwan

“…This issue can be addressed from various perspectives, such as employing communication tools to facilitate information exchange between hospitals, expediting patient assessment after transfer, and accelerating subsequent time metrics. 20,21 Flying EST teams to remote areas can also help overcome the challenge of limited access to acute stroke care, leading to better outcomes for patients. 22 Moreover, reducing unnecessary referrals is an important hurdle to overcome.…”

Expert Consensus on Improving Stroke Care Ecosystem in India

“…32 A Taiwanese retrospective study on a smartphone application for interhospital transfer in thrombectomy for large vessel occlusion (LVO) acute ischemic strokes (AIS) showed a decrease in door-to-puncture time from 109.3 to 92 minutes over three years ( p = .045), with increased thrombectomy cases. 35 A Brazilian study supported the efficacy of a similar app, suggesting timely data review can be as accurate as the physical presence of stroke experts. 36 A review by Bonura et al found mobile apps beneficial in stroke care but highlighted a need for more interactive systems for clinicians in primary prevention, acute management and post-acute stroke care.…”

Predictors of unfavorable outcome at 90 days in basilar artery occlusion patients

“…The China Medical University Hospital (CMUH) is located in central Taiwan and has a 2054-bed capacity. The stroke center treats approximately 1300 acute ischemic stroke patients and performs 90 tissue plasminogen activator (tPA) thrombolysis procedures and 120 intra-arterial thrombectomies annually[ 12 ].…”