Zainab Magdon-Ismail1, Curtis Benesch2, Jeremy T Cushman2, Ian Brissette2, Andrew M Southerland2, Ethan S Brandler2, Cemal B Sozener2, Sue Flor2, Roseanne Hemmitt2, Kathleen Wales2, Krystal Parrigan2, Steven R Levine2. 1. From the American Heart Association/American Stroke Association, Albany (Z.M.-I., S.F., R.H.); University of Rochester Medical Center, NY (C.B., J.T.C.); New York State Department of Health, Albany (I.B., K.W., K.P.); University of Virginia Health System, Charlottesville (A.M.S.); SUNY Stony Brook Medicine, NY (E.S.B.); University of Michigan Health System, Ann Arbor (C.B.S.); and SUNY Downstate College of Medicine & Medical Center and Kings County Hospital Center, Brooklyn, NY (S.R.L.). zmagdon@heart.org. 2. From the American Heart Association/American Stroke Association, Albany (Z.M.-I., S.F., R.H.); University of Rochester Medical Center, NY (C.B., J.T.C.); New York State Department of Health, Albany (I.B., K.W., K.P.); University of Virginia Health System, Charlottesville (A.M.S.); SUNY Stony Brook Medicine, NY (E.S.B.); University of Michigan Health System, Ann Arbor (C.B.S.); and SUNY Downstate College of Medicine & Medical Center and Kings County Hospital Center, Brooklyn, NY (S.R.L.).
Abstract
BACKGROUND AND PURPOSE: The American Heart Association/American Stroke Association and Department of Health Stroke Coverdell Program convened a stakeholder meeting in upstate NY to develop recommendations to enhance stroke systems for acute large vessel occlusion. METHODS: Prehospital, hospital, and Department of Health leadership were invited (n=157). Participants provided goals/concerns and developed recommendations for prehospital triage and interfacility transport, rating each using a 3-level impact (A [high], B, and C [low]) and implementation feasibility (1 [high], 2, and 3 [low]) scale. Six weeks later, participants finalized recommendations. RESULTS: Seventy-one stakeholders (45% of invitees) attended. Six themes around goals/concerns emerged: (1) emergency medical services capacity, (2) validated prehospital screening tools, (3) facility capability, (4) triage/transport guidelines, (5) data capture/feedback tools, and (6) facility competition. In response, high-impact (level A) prehospital recommendations, stratified by implementation feasibility, were (1) use of online medical control for triage (6%); (2) regional transportation strategy (31%), standardized emergency medical services checklists (18%), quality metrics (14%), standardized prehospital screening tools (13%), and feedback for performance improvement (7%); and (3) smartphone application algorithm for screening/decision-making (6%) and ambulance-based telemedicine (6%). Level A interfacility transfer recommendations were (1) standardized transfer process (32%)/timing goals (16%)/regionalized systems (11%), performance metrics (11%), image sharing capabilities (7%); (2) provider education (9%) and stroke toolbox (5%); and (3) interfacility telemedicine (7%) and feedback (2%). CONCLUSIONS: The methods used and recommendations generated provide models for stroke system enhancement. Implementation may vary based on geographic need/capacity and be contingent on establishing standard care practices. Further research is needed to establish optimal implementation strategies.
BACKGROUND AND PURPOSE: The American Heart Association/American Stroke Association and Department of Health Stroke Coverdell Program convened a stakeholder meeting in upstate NY to develop recommendations to enhance stroke systems for acute large vessel occlusion. METHODS: Prehospital, hospital, and Department of Health leadership were invited (n=157). Participants provided goals/concerns and developed recommendations for prehospital triage and interfacility transport, rating each using a 3-level impact (A [high], B, and C [low]) and implementation feasibility (1 [high], 2, and 3 [low]) scale. Six weeks later, participants finalized recommendations. RESULTS: Seventy-one stakeholders (45% of invitees) attended. Six themes around goals/concerns emerged: (1) emergency medical services capacity, (2) validated prehospital screening tools, (3) facility capability, (4) triage/transport guidelines, (5) data capture/feedback tools, and (6) facility competition. In response, high-impact (level A) prehospital recommendations, stratified by implementation feasibility, were (1) use of online medical control for triage (6%); (2) regional transportation strategy (31%), standardized emergency medical services checklists (18%), quality metrics (14%), standardized prehospital screening tools (13%), and feedback for performance improvement (7%); and (3) smartphone application algorithm for screening/decision-making (6%) and ambulance-based telemedicine (6%). Level A interfacility transfer recommendations were (1) standardized transfer process (32%)/timing goals (16%)/regionalized systems (11%), performance metrics (11%), image sharing capabilities (7%); (2) provider education (9%) and stroke toolbox (5%); and (3) interfacility telemedicine (7%) and feedback (2%). CONCLUSIONS: The methods used and recommendations generated provide models for stroke system enhancement. Implementation may vary based on geographic need/capacity and be contingent on establishing standard care practices. Further research is needed to establish optimal implementation strategies.
Authors: Jacob R Morey; Brian D Kim; Michael Redlener; Xiangnan Zhang; Naoum Fares Marayati; Stavros Matsoukas; Emily Fiano; Laura K Stein; J Mocco; Johanna T Fifi Journal: J Stroke Date: 2022-09-30 Impact factor: 8.632
Authors: Kori S Zachrison; Latha Ganti; Dhruv Sharma; Pawan Goyal; Marquita Decker-Palmer; Opeolu Adeoye; Joshua N Goldstein; Edward C Jauch; Bruce M Lo; Tracy E Madsen; William Meurer; John A Oostema; Cindy Mendez-Hernandez; Arjun K Venkatesh Journal: J Am Coll Emerg Physicians Open Date: 2022-07-22
Authors: Kori S Zachrison; Thabele M Leslie-Mazwi; Gregoire Boulouis; Joshua N Goldstein; Robert W Regenhardt; Anand Viswanathan; Arne Lauer; Khawdja Ahmer Siddiqui; Andreas Charidimou; Natalia Rost; Lee H Schwamm Journal: Neurol Clin Pract Date: 2019-10
Authors: Kori S Zachrison; Jukka-Pekka Onnela; Mathew J Reeves; Adrian Hernandez; Carlos A Camargo; Xin Zhao; Roland A Matsouaka; Joshua N Goldstein; Joshua P Metlay; Lee H Schwamm Journal: J Am Heart Assoc Date: 2019-12-31 Impact factor: 5.501