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Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care

Version 3 2024-06-15, 20:47
Version 2 2024-06-06, 03:29
Version 1 2022-11-22, 05:26
journal contribution
posted on 2024-06-15, 20:47 authored by CF Bladin, KL Bagot, M Vu, J Kim, S Bernard, K Smith, G Hocking, T Coupland, D Pearce, D Badcock, M Budge, V Nadurata, W Pearce, H Hall, B Kelly, A Spencer, P Chapman, E Oqueli, R Sahathevan, Thomas Kraemer, C Hair, D Stub, DA Cadilhac
ObjectivesTo determine if a digital communication app improves care timelines for patients with suspected acute stroke/ST-elevation myocardial infarction (STEMI).DesignReal-world feasibility study, quasi-experimental design.SettingPrehospital (25 Ambulance Victoria branches) and within-hospital (2 hospitals) in regional Victoria, Australia.ParticipantsParamedics or emergency department (ED) clinicians identified patients with suspected acute stroke (onset <4.5 hours; n=604) or STEMI (n=247).InterventionThe 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 measureDoor-to-treatment (needle for stroke, balloon for STEMI) Secondary outcome measures: ambulance and hospital processes.ResultsStroke (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).ConclusionsIn this Australian-first study, uptake of the digital communication app was strong, patient-centred care timelines improved, although door-to-treatment times remained similar.

History

Journal

BMJ Open

Volume

12

Article number

e052332

Pagination

1-8

Location

London, Eng.

ISSN

2044-6055

eISSN

2044-6055

Language

English

Publication classification

C1 Refereed article in a scholarly journal

Issue

7

Publisher

BMJ Publishing Group