EDITOR'S NOTE: Special thanks to our guest bloggers, Casey B. Patrick, MD, FACEP, and Robert L. Dickson, MD, FAAEM, FACEP, FACEM of Montgomery County Hospital District EMS.

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There are more than 700,000 strokes in the U.S. every year, and stroke is the number one cause of disability in our country. It’s estimated that up to one third of ischemic strokes are large-vessel occlusion (LVO) strokes.¹ These occur in the large blood vessels that supply the brain, specifically the internal carotid, middle cerebral, and basilar arteries. Given the large portions of the brain supplied with blood by these arteries, these types of ischemic strokes cause significant morbidity and mortality.

One of the biggest contributors to inefficiency in healthcare is a lack of communication, which can lead to lower quality of care and higher costs. Communication in healthcare is siloed for many reasons, including the complexity of the work, the size of health systems, outdated and non-integrated communication technologies, and HIPAA constraints.

"We do really well inside of each team [in terms of communication] … but when we try to cross those disciplines, or actually go between facilities, we start to see a breakdown or dissolution in the quality of information," said Forrest Winslow, clinical specialist at health IT company Pulsara.

FOR IMMEDIATE RELEASE

Combination of Pulsara and RAPID expands window of opportunity for treatment 

BOZEMAN, MT – September 27, 2019 – Miami Valley Hospital is the first site in the world to use the combination of a specific software application and mobile platform to enhance the treatment used to preserve a patient’s neurological function after a stroke.

While many hospitals use both applications – Pulsara and RAPID – in their stroke care, none have taken the step to combine their capabilities into one, said John Terry, MD, director of inpatient stroke care at Miami Valley Hospital.

Pulsara, a mobile platform, was developed by physicians to improve coordination and communication essential for stroke patient assessment. RAPID is a global leader in advanced imaging.

When I was fresh out of Paramedic school, STEMI and stroke patients were something we couldn’t do much about except monitor and transport. To be honest, we hadn’t even started using the term "STEMI," and we were years away from giving aspirin. Patients who survived to get discharged out of the CCU or ICU (there were no stroke units then) went on to rehab or an extended care facility with a shoebox full of meds. They were armed with lots of Digitalis and Lasix, but not much hope.

EDITOR'S NOTE: Alyana Samai is the Director of Stroke Services at West Jefferson Medical Center in Marrero, Louisiana. Aly has been a champion user of Pulsara since 2016, and has led her teams to successfully decrease door to needle times by streamlining and improving communication when it matters most. 

Dear Aly,

We are new clients and implementing Pulsara at our facility, but many of our nurses are concerned that this is going to be "double documentation," more than communication. How can we help them understand that Pulsara can streamline the process, reduce communication frustrations, and not double up on tasks?

Sincerely, 
Prepared for Pulsara

BACKGROUND

Virginia Mason Medical Center is a nonprofit health care system based in King County, Seattle, serving the central Puget Sound region and Yakima area.

PROBLEM

Focused on continually delivering the highest quality of care to patients, care teams at Virginia Mason Medical Center wanted to innovate the way they communicated with one another to better respond to time-sensitive stroke cases.

The Montgomery County Hospital District EMS experience paired a novel stroke assessment endovascular pathway with specialized training.

Earlier this month, The Journal of NeuroInterventional Surgery published a research review which examined the impacts of various technologies on the optimization of care delivery for Emergent Large Vessel Occlusion (ELVO) stroke, specifically in the prehospital environment. Because the benefits of endovascular treatment have been established, a new focus on reducing the time it takes to get patients to treatment at the most appropriate facility has emerged.

The report states that "Having early diagnostics allows for earlier activation of interventional teams and subsequently more reperfusions, faster reperfusions, shorter ED triage, and shorter door-to-balloon times," and further, "Time saved translates into disability-free life for our patients."