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

Abstract

OBJECTIVES:

To determine if a digital communication app improves care timelines for patients with suspected acute stroke/ST-elevation myocardial infarction (STEMI).

DESIGN:

Real-world feasibility study, quasi-experimental design.

SETTING:

Prehospital (25 Ambulance Victoria branches) and within-hospital (2 hospitals) in regional Victoria, Australia.

PARTICIPANTS:

Paramedics or emergency department (ED) clinicians identified patients with suspected acute stroke (onset <4.5 hours; n=604) or STEMI (n=247).

INTERVENTION:

The 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 MEASURE:

Door-to-treatment (needle for stroke, balloon for STEMI) Secondary outcome measures: ambulance and hospital processes.

RESULTS:

Stroke (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).

CONCLUSIONS:

In this Australian-first study, uptake of the digital communication app was strong, patient-centred care timelines improved, although door-to-treatment times remained similar.

• 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 (BMJ Open) Vol. 12 Issue 7 Pg. e052332 (07 18 2022) ISSN: 2044-6055 [Electronic] England
• PMID: 35851025 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Ambulances
• Arrhythmias, Cardiac
• Communication
• Electrocardiography
• Emergency Medical Services
• Feasibility Studies
• Female
• Humans
• Male
• Mobile Applications
• Myocardial Infarction (therapy)
• ST Elevation Myocardial Infarction (therapy)
• Stroke (therapy)
• Time Factors
• Treatment Outcome
• Victoria