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. 2022 Jul 18;12(7):e052332.
doi: 10.1136/bmjopen-2021-052332.

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

Chris F Bladin  1   2   3 , Kathleen L Bagot  2   4 , Michelle Vu  5 , Joosup Kim  2   4 , Stephen Bernard  6 , Karen Smith  7   8 , Grant Hocking  6 , Tessa Coupland  9 , Debra Pearce  10 , Diane Badcock  9 , Marc Budge  9 , Voltaire Nadurata  9 , Wayne Pearce  6 , Howard Hall  6 , Ben Kelly  10 , Angie Spencer  10 , Pauline Chapman  10 , Ernesto Oqueli  10   11 , Ramesh Sahathevan  10   12 , Thomas Kraemer  10 , Casey Hair  10 , Dion Stub  6   8 , Dominique A Cadilhac  2   4
Affiliations

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

Chris F Bladin et al. BMJ Open. .

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.

Keywords: ACCIDENT & EMERGENCY MEDICINE; CARDIOLOGY; Organisation of health services; Stroke.

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Conflict of interest statement

Competing interests: None of the authors have a financial interest in the Pulsara app or Pulsara Communicare Technology. KB and DAC received a travel grant paid to their institution from Pulsara Communicare Technology. This grant was a contribution to defray the costs of attending an international conference to present the final results. The peer-reviewed abstract submission was accepted prior to receiving the travel grant. The company had no input to the content of the abstracts or the presentations (nor this manuscript).

Figures

Figure 1
Figure 1
Screen shots Pulsara stop stroke/STEMI (V.4.6 originally implemented June 2016, V.11 in use November 2020): (A) select patient condition, (B) enter patient symptoms, (C) adding images (eg, driver’s licence) or messages, (D) alert emergency department. see www.Pulsara.com for video. STEMI, ST-elevation myocardial infarction.
See this image and copyright information in PMC

References

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