Remote Longitudinal Inpatient Acute Stroke Care Via Telestroke
Autor: | Matthew Starr, Marcelo Rocha, Ashutosh P Jadhav, Tudor G Jovin, Fatemeh Sobhani, Evan S Madill, Shashvat M Desai, Bradley J. Molyneaux, Lawrence Wechsler |
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Rok vydání: | 2021 |
Předmět: |
Male
Patient Transfer medicine.medical_specialty Telemedicine Time Factors medicine.medical_treatment Pilot Projects Patient Readmission 03 medical and health sciences Disability Evaluation 0302 clinical medicine Patient Admission Medicine Humans In patient Prospective cohort study Acute stroke Aged Ischemic Stroke Retrospective Studies Aged 80 and over Inpatients business.industry Mortality rate Remote Consultation Rehabilitation Emergency department Thrombolysis Recovery of Function Length of Stay Middle Aged Functional Status Treatment Outcome Ischemic Attack Transient Emergency medicine Ischemic stroke Surgery Female Neurology (clinical) Cardiology and Cardiovascular Medicine business Emergency Service Hospital 030217 neurology & neurosurgery |
Zdroj: | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 30(6) |
ISSN: | 1532-8511 |
Popis: | Objectives While telestroke ‘hub-and-spoke’ systems are a well-established model for improving acute stroke care at spoke facilities, utility beyond the hyperacute phase is unknown. In patients receiving intravenous thrombolysis via telemedicine, care at spoke facilities has been shown to be associated with longer length of stay and worse outcomes. We sought to explore the impact of ongoing stroke care by a vascular neurologist via telemedicine compared to care provided by local neurologists. Methods A network spoke facility protocol was revised to pilot telestroke consultation with a hub vascular neurologist for all patients presenting to the emergency department with ischemic stroke or transient ischemic attack regardless of time since onset or severity. Subsequent telestroke rounds were performed for patients who received initial telestroke consultation. Key outcome measures were length of stay, 30-day readmission and mortality and 90-day mRS. Results during the pilot (post-cohort) were compared to the same hospital's previous outcomes (pre-cohort). Results Of 257 enrolled patients, 67% were in the post-cohort. Forty percent (69) of the post-cohort received an initial telestroke consult. In spoke-retained patients followed by telestroke rounds (55), median length of stay decreased by 0.8 days (P = 0.01). Readmission and mortality rates did not differ significantly between groups (19.5 vs. 9.1%, P = 0.14 and 3.9 vs. 3.6%, P = 1, respectively). The favorable functional outcome rate was similar between groups (47.3% vs 65.9%, P = 0.50). Conclusions Longitudinal stroke care via telestroke may be economically viable through length of stay reduction. Randomized prospective studies are needed to confirm our findings and further investigate this model's potential benefits. |
Databáze: | OpenAIRE |
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