Bernd Griewing

Mobile computing systems in preclinical care of stroke. Results of the Stroke Angel initiative within the BMBF project PerCoMed

BACKGROUND Telemedical networks that apply innovative mobile information technologies (IT) are an innovative approach to improve stroke care in community settings. Within the German Stroke Angel initiative and the research project PerCoMed (Pervasive Computing in Medical Care, funded by the Federal Ministry of Education and Research, http://www.percomed.de) the effects of such a solution were assessed by an interdisciplinary research approach. The main goal of the team of researchers and practitioners was to provide clear evidence of improvements in intersectional processes of the stroke chain survival, namely in the acute stroke processes between prehospital rescue services and hospital stroke units. MATERIAL AND METHODS Between October 2005 and October 2007 the paramedical staff of five rescue service transporters in a rural area of northern Bavaria was included in a network with the stroke unit of the Neurological Clinic Bad Neustadt. Telemedical support by the Stroke Angel computing system - a software running on a personal digital assistant (PDA) to transmit patient data from the rescue team to the hospital during patient transporting time - was established. As procedural guidance, the Stroke Angel system suggests a predefined path through the necessary emergency procedures according to the structure of the mandatory protocol and the implemented Los Angeles Prehospital Stroke Screen (LAPSS). RESULTS In the empirical study the authors obtained a complete data set of 226 consecutively admitted patients for analysis in Bad Neustadt and LAPSS data of 217 patients from a second scenario in Düsseldorf. Medical, economic and technical analyses were applied. The technological robustness of the Stroke Angel system could be proven and information entered was transmitted fully and correctly. Concerning medical research questions, for both scenario locations LAPSS with a sensitivity of 68.3% and a specificity of 85.1% has to be deemed insufficient. Hence, alternative algorithms will have to be used in the next steps of evaluation. The system significantly influenced the clinical process of acute stroke management more than the preclinical ones (door-to-CT: 32 min. before and 16 min. at the end of the project). Lysis treatment rose from 6.12% (2005) to 11.17% (2007) of patients with acute stroke. CONCLUSIONS From the set of perspectives taken, the study illustrates that mobile computing technologies offer new and innovative approaches to improve intersectional acute stroke care. It also teaches the participants that interdisciplinary research can significantly deepen the understanding of such technologies and projects, which can lead to better decision making concerning solution implementation, management and improvements. The approach will be brought into daily practice in Bad Neustadt/Saale within the next months.

Rettungshubschrauber im Flight for Stroke

Der systematische Einsatz des Luftrettungsmittels unterstützt im ländlichen Raum die Schlaganfallversorgung, sodass mehr Patienten mit Verdacht auf akuten Schlaganfall innerhalb des Lysezeitfensters in eine Stroke Unit gebracht und lysiert werden.

Digitalisierte Gesundheitsnetzwerke mit Telemedizin: Produktive Netzwerkmedizin am Beispiel Schlaganfall

Fur den Ausbau der ambulant-stationaren Vernetzung sind sowohl die internen Strukturen in Krankenhausern durchgangig zu digitalisieren als auch sichere und flexible Plattformen zur Vernetzung eines Krankenhauses mit Arztpraxen, anderen Einrichtungen und den Patienten zu etablieren. Hierfur stellt der Beitrag den Ansatz der WebEPA+ zum sektorenubergreifenden Care Management vor, die im Sinne der Netzwerkmedizin patientenorientierte Behandlungsprozesse fordern soll. Die WebEPA+ verbindet ein Krankenhaus mit anderen Einrichtungen und macht die Daten des Krankenhauses fur andere Einrichtungen und den Patienten selbst zuganglich. Zugleich kann auf Daten anderer Einrichtungen zugreifen und diese in einer vernetzten Patientenakte zusammenfuhren. Anhand der Pilotstudie „Stroke Manager“ demonstriert dieser Beitrag den Effekt der WebEPA+ auf die sektorenubergreifende Vernetzung. Die Studie zeigt auf, dass der Stroke Manager Service positiven Einfluss auf Lebensqualitat und Gesundheitszustand der Patienten nimmt und von den Patienten als nutzlich wahrgenommen wird. Die Produktivitat des Gesundheitsnetzwerkes nimmt dann zu, wenn der Service zu einem spurbaren Zeitgewinn bei Arzten und Pflegekraften fuhrt. Dies wird in der aktuell laufenden Folgestudie untersucht.

Schlaganfall – Wenn jede Sekunde zählt

Alle 3 Minuten kommt es in Deutschland zu einem Schlaganfall – alle 9 Minuten stirbt jemand an den Folgen [1]. Je fruher ein Patient behandelt wird, desto besser sein Outcome – ganz nach dem Motto: „time isbrain“. Daher ist es wichtig, dass Sie die Symptome sofort erkennen und den Patienten so schnell wie moglich in die richtige Klinik bringen.

Einsatz mobiler Computing-Systeme in der präklinischen Schlaganfallversorgung@@@Mobile computing systems in preclinical care of stroke: Ergebnisse aus der Stroke-Angel-Initiative im Rahmen des BMBF-Projekts PerCoMed@@@Results of the Stroke Angel initiative within the BMBF project PerCoMed

BACKGROUND Telemedical networks that apply innovative mobile information technologies (IT) are an innovative approach to improve stroke care in community settings. Within the German Stroke Angel initiative and the research project PerCoMed (Pervasive Computing in Medical Care, funded by the Federal Ministry of Education and Research, http://www.percomed.de) the effects of such a solution were assessed by an interdisciplinary research approach. The main goal of the team of researchers and practitioners was to provide clear evidence of improvements in intersectional processes of the stroke chain survival, namely in the acute stroke processes between prehospital rescue services and hospital stroke units. MATERIAL AND METHODS Between October 2005 and October 2007 the paramedical staff of five rescue service transporters in a rural area of northern Bavaria was included in a network with the stroke unit of the Neurological Clinic Bad Neustadt. Telemedical support by the Stroke Angel computing system - a software running on a personal digital assistant (PDA) to transmit patient data from the rescue team to the hospital during patient transporting time - was established. As procedural guidance, the Stroke Angel system suggests a predefined path through the necessary emergency procedures according to the structure of the mandatory protocol and the implemented Los Angeles Prehospital Stroke Screen (LAPSS). RESULTS In the empirical study the authors obtained a complete data set of 226 consecutively admitted patients for analysis in Bad Neustadt and LAPSS data of 217 patients from a second scenario in Düsseldorf. Medical, economic and technical analyses were applied. The technological robustness of the Stroke Angel system could be proven and information entered was transmitted fully and correctly. Concerning medical research questions, for both scenario locations LAPSS with a sensitivity of 68.3% and a specificity of 85.1% has to be deemed insufficient. Hence, alternative algorithms will have to be used in the next steps of evaluation. The system significantly influenced the clinical process of acute stroke management more than the preclinical ones (door-to-CT: 32 min. before and 16 min. at the end of the project). Lysis treatment rose from 6.12% (2005) to 11.17% (2007) of patients with acute stroke. CONCLUSIONS From the set of perspectives taken, the study illustrates that mobile computing technologies offer new and innovative approaches to improve intersectional acute stroke care. It also teaches the participants that interdisciplinary research can significantly deepen the understanding of such technologies and projects, which can lead to better decision making concerning solution implementation, management and improvements. The approach will be brought into daily practice in Bad Neustadt/Saale within the next months.