e-Bridge Stroke Module

Stroke Workflow

Improving Stroke Workflow and Case Data Collection with Mobile Telemedicine 

THE CHALLENGE

According to the CDC, 1 out of every 20 deaths is caused by a stroke. Stroke patients risk losing up to 2 million brain cells every minute. GD knows that every second count when it comes to stroke patients. ED and Stroke teams need to focus on improving door to needle time as well as creating a collection of data that will help the future outcomes of the patient. Using mobile telemedicine solutions, ED and Stroke teams have access to not only improving the patient outcome but also the benchmarks of the team as a whole; creating a more cohesive and collaborative team environment.

Through the use of a specialized digital mobile telemedicine app, EMS and Stroke teams are uniquely positioned to improve the saving of lives through timely intervention with engaging hospital and stroke teams via app features to initiate broader acute workflow improvements. Multi-faceted alerts including data collection and vitals shared real-time with ETA tracking to providers, speeds treatment and engagement to improve outcomes while adding short and long-term educational value. A vital part of stroke case is making sure treatment is handled in a timely manner. Having a configurable mobile telemedicine solution allows for ED and stroke teams to effectively communicate in order to properly treat the patient.

THE SOLUTION

The stroke case workflow process utilizes GD’s e-Bridge Workflow mobile telemedicine app. The solution provides an easy to use, state or region mechanism to alert, notify and track all stroke cases in real time from prehospital first medical contact through the emergency department, handoff to stroke teams. This will help the stroke team be better prepared for the inbound patient while lessening the handoff time and increasing data accuracy.

Note that all e-Bridge Workflow templates are highly configurable. Allowing flexibility to operate protocols your way, ensuring maximum effectiveness and compliance to your teams and sepsis accreditations.

SAMPLE TELESTROKE WORKFLOW

1. 911 communications receive a call for a possible sepsis and dispatch EMS
2. EMS receives the CAD location information and response
3. Dispatch & arrival times documented in CAD
4. Upon arrival, EMS’ patient assessment identifies possible stroke case
5. Once stroke assessment is conducted EMS selects the destination/hospital
6. EMS clicks the “Stroke” button of the e-Bridge app on their mobile device and treats the patient. The location is tagged and the running clock begins*
7. The highly configurable workflow template prompts for initial patient demographic*, driver’s license, ID scan/picture, and medical incident and treatment information
8. Notifications for events are time stamped, logged and shared in real time with preselected team members via e-Bridge (ED computer, mobile devices, etc.)
9. Existing or newly assigned specialists can be notified and added to the team; either preconfigured or at any point by ED
10. Live (synchronous) or asynchronous video consult with a physician, specialist, etc. is available. Secure multi-media such as pictures, video, audio, text, team chat and vital sign and ECG sharing is available
11. If transporting, live ETA is sent to receiving hospital and specialists once in route

12. If AMA refusal, video consult with physician or specialist may avert refusal, otherwise video documentation of refusal is used to mitigate risk
13. Hospital ED physician/nurse to notify registration to the case, allowing them to pre-register the patient before arrival
14. ED team member assigns bed and EMS is notified pre-arrival, via the app
15. Hospital ED can see tracking map with priority and live ETA. Once the ambulance is within “geofence” of the hospital an “arrival” alert is announced and displayed and team members are alerted on the e-Bridge app
16. ED team assesses the need for a CT lab scan
17. EMS arrives and moves the patient to the pre-assigned bed/ lab and hands off the patient to ED staff that is already prepared and ready with a pre-registered ID wristband
18. ED staff take over patient care and the pre-hospital phase has ended
19. EMS clears us from the call and goes back in service but is available for questions, team chat, notifications, and outcome results, via the e-Bridge app
20. Downstream outcome feedback/status is entered by hospital staff, EMS is notified via e-Bridge of the results for continuous improvement

EXPECTED RESULTS

  • Process improvement for stroke intervention and flow
  • Automated case management
  • Timestamped and recorded metrics
  • Increase tPA usage
  • Proactively prepare labs
  • Reduce false lab activations
  • Online medical control
  • Feedback and benchmarking
  • Smoother patient handoff
  • Communication with EMS on outcome data
  • Continued education and training for stroke teams and EMS officials based on trend report and time studies
  • EMS transfer and follow up performed easier
  • Consistency in working protocols

METRICS TO TRACK

  • tPA utilization
  • 5-hour criteria
  • Metrics of success
  • Costs saved

It all starts by taking the first step!