REACH MUSC: A telemedicine facilitated network for urgent stroke: initial experience
REACH MUSC provides stroke consults via the internet in South Carolina. From May 2008 to April 2011 231 patients were treated with intravenous (IV) thrombolysis and 369 were transferred to Medical University of South Carolina (MUSC) including 42 for intra-arterial revascularization (with or withou...
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doaj-5f3d3a02fd424095bdb3289601db336e2020-11-25T00:48:58ZengFrontiers Media S.A.Frontiers in Neurology1664-22952012-03-01310.3389/fneur.2012.0003316749REACH MUSC: A telemedicine facilitated network for urgent stroke: initial experienceRobert J. Adams0Ellen eDebenham1Julio eChalela2Marc eChimowitz3Angela eHays4Cody eHill5Christine eHolmstedt6Edward C Jauch7Alec eKitch8Christos eLazaridis9Tanya N Turan10Medical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaMedical University of South CarolinaREACH MUSC provides stroke consults via the internet in South Carolina. From May 2008 to April 2011 231 patients were treated with intravenous (IV) thrombolysis and 369 were transferred to Medical University of South Carolina (MUSC) including 42 for intra-arterial revascularization (with or without IV tPA). Medical outcomes and hemorrhage rates, reported elsewhere, were good (Lazaridis et al. 2011, in press). Here we report operational features of REACH MUSC which covers 15 sites with 2,482 beds and 471,875 Emergency Department (ED) visits per year. Eight Academic Faculty from MUSC worked with 165 different physicians and 325 different nurses in the conduct of 1085 consults. For the 231 who received tissue plasminogen activator (tPA), time milestones were: Onset to Door: 62 min (mean), 50 (median); Door to REACH Consult: 43 and 33, Consult Request to Consult Start: was 9 and 7 minutes, Consult Start to tPA Decision: 31 and 25 minutes; Decision to Infusion: 20 and 14 minutes, and total Door to Needle: 98 and 87 minutes. The comparable times for the 854 not receiving tPA were: Onset to Door: 140 and 75 minutes; Door to REACH Consult: 61 and 41 minutes; Consult Request to Consult Start 9 and 7 minutes, Consult Start to tPA Decision 27 and 23 minutes. While the consultants respond to consult requests in < 10 minutes, there is a long delay between arrival and Consult request. Tracking of operations indicates if we target shortening Door to Call time and time from tPA decision to start of drug infusion we may be able to improve Door to Needle times to target of < 60 minutes. The large number of individuals involved in the care of these patients, most of whom had no training in REACH usage,will require novel approaches to staff education in ED based operations where turnover is high. Despite these challenges this robust system delivered tPA safely and in a high fraction of patients evaluated using the REACH MUSC system.http://journal.frontiersin.org/Journal/10.3389/fneur.2012.00033/fullStrokeTelemedicineThrombectomynetworkthrombolysisaccess to care |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Robert J. Adams Ellen eDebenham Julio eChalela Marc eChimowitz Angela eHays Cody eHill Christine eHolmstedt Edward C Jauch Alec eKitch Christos eLazaridis Tanya N Turan |
spellingShingle |
Robert J. Adams Ellen eDebenham Julio eChalela Marc eChimowitz Angela eHays Cody eHill Christine eHolmstedt Edward C Jauch Alec eKitch Christos eLazaridis Tanya N Turan REACH MUSC: A telemedicine facilitated network for urgent stroke: initial experience Frontiers in Neurology Stroke Telemedicine Thrombectomy network thrombolysis access to care |
author_facet |
Robert J. Adams Ellen eDebenham Julio eChalela Marc eChimowitz Angela eHays Cody eHill Christine eHolmstedt Edward C Jauch Alec eKitch Christos eLazaridis Tanya N Turan |
author_sort |
Robert J. Adams |
title |
REACH MUSC: A telemedicine facilitated network for urgent stroke: initial experience |
title_short |
REACH MUSC: A telemedicine facilitated network for urgent stroke: initial experience |
title_full |
REACH MUSC: A telemedicine facilitated network for urgent stroke: initial experience |
title_fullStr |
REACH MUSC: A telemedicine facilitated network for urgent stroke: initial experience |
title_full_unstemmed |
REACH MUSC: A telemedicine facilitated network for urgent stroke: initial experience |
title_sort |
reach musc: a telemedicine facilitated network for urgent stroke: initial experience |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2012-03-01 |
description |
REACH MUSC provides stroke consults via the internet in South Carolina. From May 2008 to April 2011 231 patients were treated with intravenous (IV) thrombolysis and 369 were transferred to Medical University of South Carolina (MUSC) including 42 for intra-arterial revascularization (with or without IV tPA). Medical outcomes and hemorrhage rates, reported elsewhere, were good (Lazaridis et al. 2011, in press). Here we report operational features of REACH MUSC which covers 15 sites with 2,482 beds and 471,875 Emergency Department (ED) visits per year. Eight Academic Faculty from MUSC worked with 165 different physicians and 325 different nurses in the conduct of 1085 consults. For the 231 who received tissue plasminogen activator (tPA), time milestones were: Onset to Door: 62 min (mean), 50 (median); Door to REACH Consult: 43 and 33, Consult Request to Consult Start: was 9 and 7 minutes, Consult Start to tPA Decision: 31 and 25 minutes; Decision to Infusion: 20 and 14 minutes, and total Door to Needle: 98 and 87 minutes. The comparable times for the 854 not receiving tPA were: Onset to Door: 140 and 75 minutes; Door to REACH Consult: 61 and 41 minutes; Consult Request to Consult Start 9 and 7 minutes, Consult Start to tPA Decision 27 and 23 minutes. While the consultants respond to consult requests in < 10 minutes, there is a long delay between arrival and Consult request. Tracking of operations indicates if we target shortening Door to Call time and time from tPA decision to start of drug infusion we may be able to improve Door to Needle times to target of < 60 minutes. The large number of individuals involved in the care of these patients, most of whom had no training in REACH usage,will require novel approaches to staff education in ED based operations where turnover is high. Despite these challenges this robust system delivered tPA safely and in a high fraction of patients evaluated using the REACH MUSC system. |
topic |
Stroke Telemedicine Thrombectomy network thrombolysis access to care |
url |
http://journal.frontiersin.org/Journal/10.3389/fneur.2012.00033/full |
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