Dickson R, Nedelcut A, Nedelcut MM. Stop stroke: A brief report on door-to-needle times and performance after implementing an acute care coordination medical application and implications to emergency medical services. Prehosp Disaster Med. 2017;32(3):1-5.
High-acuity EMS patients, such as those suffering traumatic injuries, stroke or acute myocardial infarction, often benefit from timely administration of definitive care. Optimizing systems of care between out-of-hospital and in-hospital practitioners is one method of ensuring patients receive needed emergency care as expeditiously as possible.
Kudos to these authors for evaluating if the Stop Stroke medical application by Pulsara might impact the delivery of care provided to patients experiencing an acute ischemic stroke.
Background: Acute ischemic stroke causes 5% of all deaths in the United States annually.The definitive care for patients experiencing acute ischemic stroke is the administration of tissue plasminogen activator (tPA), which may be supplemented by endovascular interventions.
Previous research has shown optimal outcomes occur when tPA is administered as proximal to the onset of symptoms as possible, with an in-hospital door-to-needle goal of 60 minutes or less. One study found a six-fold increase in onset-to-treatment time when the acute ischemic stroke patient was provided care by EMS.
Pulsara, based in Bozeman, Mont., has developed a medical app called Stop Stroke to assist EMS and hospitals to work together to increase the timeliness of definitive stroke care. Stop Stroke is a mobile device application that allows a clinician, EMS or in-hospital, to activate a stroke team. The initial clinician takes an image of the patient that’s shared, along with pertinent medical information, with the entire stroke team. Each stroke team member is also able to indicate his or her ability to respond to provide care for the patient.
Methods and results: This was a retrospective study of acute ischemic stroke patients arriving by EMS or private vehicle to one hospital over a 25-month period. Patients included within the study received tPA and met the inclusion criteria for reporting to the Center for Medicare and Medicaid Services (CMS). CMS doesn’t require the reporting of certain complicated cases, since these cases would skew the overall dataset and eliminate effective benchmarking.
The hospital’s stroke coordinator was blinded to the purpose of the study and asked to extract information for patients meeting inclusion criteria during the study period. The Stop Stroke app had been introduced during the 13th month of the study period, so comparisons were made between the 34 patients treated during the first 12 months before the use of the application and the 34 patients treated during the subsequent 13 months when the application was utilized. The variable of interest was the time between arrival at the facility and the administration of tPA.
After the Stop Stroke app was introduced to the facility the mean door-to-needle time for acute ischemic stroke patients dropped from 77 to 56 minutes (28% improvement; P ≤ 0.001; 95% CI, 1-10 minutes). This improved the hospital’s compliance with the door-to-needle benchmark goal of 60 minutes from 32% to 82%. EMS was involved with 71% of the cases after the introduction of the application and made a pre-arrival notification in 66% of the cases they were involved in.
Discussion: One limitation of this study, which was acknowledged by the authors, is it’s based within one hospital which already had a well-established stroke program. This limits the ability to generalize the results upon other EMS systems and hospitals. That stated, this study does show the potential for technology to improve the integration between EMS and in-hospital care. More research will need to be done to see if this result is reproducible within other EMS and hospital systems.