Lori Uscher-Pines1, Jessica Sousa2, Kori Zachrison3, Amy Guzik4, Lee Schwamm5, Ateev Mehrotra6. 1. RAND Corporation, Arlington VA 703-413-1100, U.S.A.. Electronic address: luscherp@rand.org. 2. RAND Corporation, Boston, MA; 703-413-1100, U.S.A. 3. Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston MA; 617-724-4100, U.S.A. 4. Wake Forest School of Medicine, Winston-Salem NC; (336) 716-9253, U.S.A. 5. Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; (617) 724-6400, U.S.A. 6. Harvard Medical School, Boston MA; 617-432-3905, U.S.A.
Abstract
OBJECTIVE: Although many emergency departments (EDs) have telestroke capacity, it is unclear why some EDs consistently use telestroke and others do not. We compared the characteristics and practices of EDs with robust and low assimilation of telestroke. METHODS: We conducted semi-structured interviews with representatives of EDs that received telestroke services from 10 different networks and had used telestroke for a minimum of two years. We used maximum diversity sampling to select EDs for inclusion and applied a positive deviance approach, comparing programs with robust and low assimilation. Data collection was informed by the Consolidated Framework for Implementation Research. For the qualitative analysis, we created site summaries and conducted a supplemental matrix analysis to identify themes. RESULTS: Representatives from 21 EDs with telestroke, including 11 with robust assimilation and 10 with low assimilation, participated. In EDs with robust assimilation, telestroke workflow was highly protocolized, programs had the support of leadership, telestroke use and outcomes were measured, and individual providers received feedback about their telestroke use. In EDs with low assimilation, telestroke was perceived to increase complexity, and ED physicians felt telestroke did not add value or had little value beyond a telephone consult. EDs with robust assimilation identified four sets of strategies to improve assimilation: strengthening relationships between stroke experts and ED providers, improving and standardizing processes, addressing resistant providers, and expanding the goals and role of the program. CONCLUSION: Greater assimilation of telestroke is observed in EDs with standardized workflow, leadership support, ongoing evaluation and quality improvement efforts, and mechanisms to address resistant providers.
OBJECTIVE: Although many emergency departments (EDs) have telestroke capacity, it is unclear why some EDs consistently use telestroke and others do not. We compared the characteristics and practices of EDs with robust and low assimilation of telestroke. METHODS: We conducted semi-structured interviews with representatives of EDs that received telestroke services from 10 different networks and had used telestroke for a minimum of two years. We used maximum diversity sampling to select EDs for inclusion and applied a positive deviance approach, comparing programs with robust and low assimilation. Data collection was informed by the Consolidated Framework for Implementation Research. For the qualitative analysis, we created site summaries and conducted a supplemental matrix analysis to identify themes. RESULTS: Representatives from 21 EDs with telestroke, including 11 with robust assimilation and 10 with low assimilation, participated. In EDs with robust assimilation, telestroke workflow was highly protocolized, programs had the support of leadership, telestroke use and outcomes were measured, and individual providers received feedback about their telestroke use. In EDs with low assimilation, telestroke was perceived to increase complexity, and ED physicians felt telestroke did not add value or had little value beyond a telephone consult. EDs with robust assimilation identified four sets of strategies to improve assimilation: strengthening relationships between stroke experts and ED providers, improving and standardizing processes, addressing resistant providers, and expanding the goals and role of the program. CONCLUSION: Greater assimilation of telestroke is observed in EDs with standardized workflow, leadership support, ongoing evaluation and quality improvement efforts, and mechanisms to address resistant providers.
Authors: Phyllis C Panzano; Helen Anne Sweeney; Beverly Seffrin; Richard Massatti; Kraig J Knudsen Journal: J Behav Health Serv Res Date: 2012-10 Impact factor: 1.505
Authors: F Akbik; J A Hirsch; R V Chandra; D Frei; A B Patel; J D Rabinov; N Rost; L H Schwamm; T M Leslie-Mazwi Journal: J Neurointerv Surg Date: 2016-03-16 Impact factor: 5.836
Authors: Opeolu Adeoye; Karin V Nyström; Dileep R Yavagal; Jean Luciano; Raul G Nogueira; Richard D Zorowitz; Alexander A Khalessi; Cheryl Bushnell; William G Barsan; Peter Panagos; Mark J Alberts; A Colby Tiner; Lee H Schwamm; Edward C Jauch Journal: Stroke Date: 2019-05-20 Impact factor: 7.914
Authors: Jessica V Richard; Andrew D Wilcock; Lee H Schwamm; Lori Uscher-Pines; Kori S Zachrison; Arham Siddiqui; Ateev Mehrotra Journal: JAMA Neurol Date: 2020-08-01 Impact factor: 18.302
Authors: Shumei Man; Ying Xian; DaJuanicia N Holmes; Roland A Matsouaka; Jeffrey L Saver; Eric E Smith; Deepak L Bhatt; Lee H Schwamm; Gregg C Fonarow Journal: JAMA Date: 2020-06-02 Impact factor: 56.272
Authors: Leah M Haverhals; George Sayre; Christian D Helfrich; Catherine Battaglia; David Aron; Lauren D Stevenson; Susan Kirsh; Michael Ho; Julie Lowery Journal: Am J Manag Care Date: 2015-12-01 Impact factor: 2.229
Authors: Anne Lambert-Kerzner; Charles Maynard; Marina McCreight; Amy Ladebue; Katherine M Williams; Kelty B Fehling; Steven M Bradley Journal: BMC Cardiovasc Disord Date: 2018-08-13 Impact factor: 2.298
Authors: Kori S Zachrison; Jessica V Richard; Andrew Wilcock; Jose R Zubizarreta; Lee H Schwamm; Lori Uscher-Pines; Ateev Mehrotra Journal: JAMA Netw Open Date: 2021-09-01