Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care
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 (...
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e052332.full |
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| author | Joosup Kim Dominique A Cadilhac Karen Smith Ramesh Sahathevan Stephen Bernard Dion Stub Voltaire Nadurata Ernesto Oqueli Thomas Kraemer Chris F Bladin Kathleen L Bagot Michelle Vu Grant Hocking Tessa Coupland Debra Pearce Diane Badcock Marc Budge Wayne Pearce Howard Hall Ben Kelly Angie Spencer Pauline Chapman Casey Hair |
| author_facet | Joosup Kim Dominique A Cadilhac Karen Smith Ramesh Sahathevan Stephen Bernard Dion Stub Voltaire Nadurata Ernesto Oqueli Thomas Kraemer Chris F Bladin Kathleen L Bagot Michelle Vu Grant Hocking Tessa Coupland Debra Pearce Diane Badcock Marc Budge Wayne Pearce Howard Hall Ben Kelly Angie Spencer Pauline Chapman Casey Hair |
| author_sort | Joosup Kim |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-ecf033ce92814cca93cd8d4b5635c200 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-ecf033ce92814cca93cd8d4b5635c2002025-01-30T21:10:09ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-052332Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI careJoosup Kim0Dominique A Cadilhac1Karen Smith2Ramesh Sahathevan3Stephen Bernard4Dion Stub5Voltaire Nadurata6Ernesto Oqueli7Thomas Kraemer8Chris F Bladin9Kathleen L Bagot10Michelle Vu11Grant Hocking12Tessa Coupland13Debra Pearce14Diane Badcock15Marc Budge16Wayne Pearce17Howard Hall18Ben Kelly19Angie Spencer20Pauline Chapman21Casey Hair22Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, AustraliaStroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia1Aummune, Tel Aviv, IsraelBallarat Health Services, Ballarat, Victoria, AustraliaAmbulance Victoria, Doncaster, Victoria, AustraliaSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, AustraliaBendigo Health, Bendigo, Victoria, AustraliaDepartment of Medicine, Deakin University, Burwood, Sydney, AustraliaBallarat Health Services, Ballarat, Victoria, AustraliaAmbulance Victoria, Doncaster, Victoria, AustraliaThe Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, AustraliaEpworth Hospital, Richmond, Victoria, AustraliaAmbulance Victoria, Doncaster, Victoria, AustraliaBendigo Health, Bendigo, Victoria, AustraliaBallarat Health Services, Ballarat, Victoria, AustraliaBendigo Health, Bendigo, Victoria, AustraliaBendigo Health, Bendigo, Victoria, AustraliaAmbulance Victoria, Doncaster, Victoria, AustraliaAmbulance Victoria, Doncaster, Victoria, AustraliaBallarat Health Services, Ballarat, Victoria, AustraliaBallarat Health Services, Ballarat, Victoria, AustraliaBallarat Health Services, Ballarat, Victoria, AustraliaBallarat Health Services, Ballarat, Victoria, AustraliaObjectives 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.https://bmjopen.bmj.com/content/12/7/e052332.full |
| spellingShingle | Joosup Kim Dominique A Cadilhac Karen Smith Ramesh Sahathevan Stephen Bernard Dion Stub Voltaire Nadurata Ernesto Oqueli Thomas Kraemer Chris F Bladin Kathleen L Bagot Michelle Vu Grant Hocking Tessa Coupland Debra Pearce Diane Badcock Marc Budge Wayne Pearce Howard Hall Ben Kelly Angie Spencer Pauline Chapman Casey Hair Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care BMJ Open |
| title | Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care |
| title_full | Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care |
| title_fullStr | Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care |
| title_full_unstemmed | Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care |
| title_short | Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care |
| title_sort | real world feasibility study to investigate the use of a multidisciplinary app pulsara to improve prehospital communication and timelines for acute stroke stemi care |
| url | https://bmjopen.bmj.com/content/12/7/e052332.full |
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