Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care. Issue 7 (18th July 2022)

• Record Type: Journal Article
• Authors: Bladin, Chris F; Bagot, Kathleen L; Vu, Michelle; Kim, Joosup; Bernard, Stephen; Smith, Karen; Hocking, Grant; Coupland, Tessa; Pearce, Debra; Badcock, Diane; Budge, Marc; Nadurata, Voltaire; Pearce, Wayne; Hall, Howard; Kelly, Ben; Spencer, Angie; Chapman, Pauline; Oqueli, Ernesto; Sahathevan, Ramesh; Kraemer, Thomas; Hair, Casey; Stub, Dion; Cadilhac, Dominique A
• Is Part Of: BMJ open. Volume 12:Issue 7(2022)
• Publication Date: 2022-07-18
• Subjects: Stroke -- ACCIDENT & EMERGENCY MEDICINE -- CARDIOLOGY -- Organisation of health services; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2021-052332
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To determine if a digital communication app improves care timelines for patients with suspected acute stroke/ST-elevation myocardial infarction (STEMI). Design: Real-world feasibility study, quasi-experimental design. Setting: Prehospital (25 Ambulance Victoria branches) and within-hospital (2 hospitals) in regional Victoria, Australia. Participants: Paramedics or emergency department (ED) clinicians identified patients with suspected acute stroke (onset <4.5 hours; n=604) or STEMI (n=247). Intervention: The Pulsara communication app provides secure, two-way, real-time communication. Assessment and treatment times were recorded for 12 months (May 2017–April 2018), with timelines compared between 'Pulsara initiated' (Pulsara) and 'not initiated' (no Pulsara). Primary outcome measure: Door-to-treatment (needle for stroke, balloon for STEMI) Secondary outcome measures: ambulance and hospital processes. Results: Stroke (no Pulsara n=215, Pulsara n=389) and STEMI (no Pulsara n=76, Pulsara n=171) groups were of similar age and sex (stroke: 76 vs 75 years; both groups 50% male; STEMI: 66 vs 63 years; 68% and 72% male). When Pulsara was used, patients were off ambulance stretcher faster for stroke (11(7, 17) vs 19(11, 29); p=0.0001) and STEMI (14(7, 23) vs 19(10, 32); p=0.0014). ED door-to-first medical review was faster (6(2, 14) vs 23(8, 67); p=0.0001) for stroke but only by 1 min for STEMI (3 (0, 7) vs 4 (0, 14); p=0.25). Door-to-CT times were 44 min faster (27(18, 44) vs 71(43, 147); p=0.0001) for stroke, and percutaneous intervention door-to-balloon times improved by 17 min, but non-significant (56 (34, 88) vs 73 (49, 110); p=0.41) for STEMI. There were improvements in the proportions of patients treated within 60 min for stroke (12%–26%, p=0.15) and 90 min for STEMI (50%–78%, p=0.20). Conclusions: In this Australian-first study, uptake of the digital communication app was strong, patient-centred care timelines improved, although door-to-treatment times remained similar.