Chris F Bladin1,2, Joosup Kim1,3, Kathleen L Bagot1,3, Michelle Vu4, Natasha Moloczij5, Sonia Denisenko6, Chris Price7, Nancy Pompeani1, Lauren Arthurson8, Casey Hair9, Justin Rabl10, Mick O'Shea11, Patrick Groot12, Leslie Bolitho13, Bruce Cv Campbell14,15, Helen M Dewey16, Geoffrey A Donnan15, Dominique A Cadilhac1,3. 1. Florey Institute of Neuroscience and Mental Health, Melbourne, VIC. 2. Ambulance Victoria, Melbourne, VIC. 3. Monash Health, Monash University, Melbourne, VIC. 4. Epworth HealthCare, Melbourne, VIC. 5. Victorian Comprehensive Cancer Centre, Melbourne, VIC. 6. Department of Health and Human Services, Melbourne, VIC. 7. Brotherhood of Saint Laurence, Melbourne, VIC. 8. Echuca Regional Health, Echuca, VIC. 9. Ballarat Health Services, Ballarat, VIC. 10. Goulburn Valley Health, Shepparton, VIC. 11. Albury Wodonga Health, Wodonga, NSW. 12. South West Healthcare, Warrnambool, VIC. 13. Northeast Health Wangaratta, Wangaratta, VIC. 14. Melbourne Health, Melbourne, VIC. 15. Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC. 16. Eastern Health, Melbourne, VIC.
Abstract
OBJECTIVES: To evaluate the impact of the Victorian Stroke Telemedicine (VST) program during its first 12 months on the quality of care provided to patients presenting with suspected stroke to hospitals in regional Victoria. DESIGN: Historical controlled cohort study comparing outcomes during a 12-month control period with those for the initial 12 months of full implementation of the VST program at each hospital. SETTING: 16 hospitals in regional Victoria that participated in the VST program between 1 January 2010 and 30 January 2016. PARTICIPANTS: Adult patients with suspected stroke presenting to the emergency departments of the participating hospitals. MAIN OUTCOME MEASURES: Indicators for key processes of care, including symptom onset-to-arrival, door-to-first medical review, and door-to-CT times; provision and timeliness of provision of thrombolysis to patients with ischaemic stroke. RESULTS: 2887 patients with suspected stroke presented to participating emergency departments during the control period, 3178 during the intervention period; the patient characteristics were similar for both periods. A slightly larger proportion of patients with ischaemic stroke who arrived within 4.5 hours of symptom onset received thrombolysis during the intervention than during the control period (37% v 30%). Door-to-CT scan time (median, 25 min [IQR, 13-49 min] v 34 min [IQR, 18-76 min]) and door-to-needle time for stroke thrombolysis (73 min [IQR, 56-96 min] v 102 min [IQR, 77-128 min]) were shorter during the intervention. The proportions of patients who received thrombolysis and had a symptomatic intracerebral haemorrhage (4% v 16%) or died in hospital (6% v 20%) were smaller during the intervention period. CONCLUSIONS: Telemedicine has provided Victorian regional hospitals access to expert care for emergency department patients with suspected acute stroke. Eligible patients with ischaemic stroke are now receiving stroke thrombolysis more quickly and safely.
OBJECTIVES: To evaluate the impact of the Victorian Stroke Telemedicine (VST) program during its first 12 months on the quality of care provided to patients presenting with suspected stroke to hospitals in regional Victoria. DESIGN: Historical controlled cohort study comparing outcomes during a 12-month control period with those for the initial 12 months of full implementation of the VST program at each hospital. SETTING: 16 hospitals in regional Victoria that participated in the VST program between 1 January 2010 and 30 January 2016. PARTICIPANTS: Adult patients with suspected stroke presenting to the emergency departments of the participating hospitals. MAIN OUTCOME MEASURES: Indicators for key processes of care, including symptom onset-to-arrival, door-to-first medical review, and door-to-CT times; provision and timeliness of provision of thrombolysis to patients with ischaemic stroke. RESULTS: 2887 patients with suspected stroke presented to participating emergency departments during the control period, 3178 during the intervention period; the patient characteristics were similar for both periods. A slightly larger proportion of patients with ischaemic stroke who arrived within 4.5 hours of symptom onset received thrombolysis during the intervention than during the control period (37% v 30%). Door-to-CT scan time (median, 25 min [IQR, 13-49 min] v 34 min [IQR, 18-76 min]) and door-to-needle time for stroke thrombolysis (73 min [IQR, 56-96 min] v 102 min [IQR, 77-128 min]) were shorter during the intervention. The proportions of patients who received thrombolysis and had a symptomatic intracerebral haemorrhage (4% v 16%) or died in hospital (6% v 20%) were smaller during the intervention period. CONCLUSIONS: Telemedicine has provided Victorian regional hospitals access to expert care for emergency department patients with suspected acute stroke. Eligible patients with ischaemic stroke are now receiving stroke thrombolysis more quickly and safely.
Authors: Chris F Bladin; Kathleen L Bagot; Michelle Vu; Joosup Kim; Stephen Bernard; Karen Smith; Grant Hocking; Tessa Coupland; Debra Pearce; Diane Badcock; Marc Budge; Voltaire Nadurata; Wayne Pearce; Howard Hall; Ben Kelly; Angie Spencer; Pauline Chapman; Ernesto Oqueli; Ramesh Sahathevan; Thomas Kraemer; Casey Hair; Dion Stub; Dominique A Cadilhac Journal: BMJ Open Date: 2022-07-18 Impact factor: 3.006
Authors: Dominique A Cadilhac; Lauren Sheppard; Joosup Kim; Elise Tan; Lan Gao; Garveeta Sookram; Helen M Dewey; Christopher F Bladin; Marj Moodie Journal: Front Neurol Date: 2021-01-21 Impact factor: 4.003
Authors: Cecilia Ostman; Carlos Garcia-Esperon; Thomas Lillicrap; Shinya Tomari; Elizabeth Holliday; Christopher Levi; Andrew Bivard; Mark W Parsons; Neil J Spratt Journal: Front Neurol Date: 2020-11-20 Impact factor: 4.003
Authors: Nicholas Richard Evans; Lynda Sibson; Diana J Day; Smriti Agarwal; Raj Shekhar; Elizabeth A Warburton Journal: BMJ Open Date: 2022-01-17 Impact factor: 2.692
Authors: Christina Tsou; Suzanne Robinson; James Boyd; Andrew Jamieson; Robert Blakeman; Justin Yeung; Josephine McDonnell; Stephanie Waters; Kylie Bosich; Delia Hendrie Journal: J Med Internet Res Date: 2021-11-26 Impact factor: 5.428
Authors: Coralie English; Kelvin Hill; Dominique A Cadilhac; Maree L Hackett; Natasha A Lannin; Sandy Middleton; Annemarei Ranta; Nigel P Stocks; Julie Davey; Steven G Faux; Erin Godecke; Bruce Cv Campbell Journal: Med J Aust Date: 2022-05-15 Impact factor: 12.776