Browsing by Author "Demaerschalk, Bart M"
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- ItemCoding for telestroke.(2014-04-04) Ingall, Timothy J; Demaerschalk, Bart M
- ItemComparison of Stroke Outcomes of Hub and Spoke Hospital Treated Patients in Mayo Clinic Telestroke Program.(0000-00-00) Demaerschalk, Bart M; Boyd, Erica L; Barrett, Kevin M; Gamble, Dale M; Sonchik, Sarah; Comer, Meghan M; Wieser, Judith; Hentz, Joseph G; Fitz-Patrick, Dennis; Chang, Yu-Hui HPURPOSE To examine telemedicine as it applies to acute ischemic stroke care at a spoke hospital and the effect on patient outcomes including the timeliness of response quality of care safety morbidity and mortality when compared to standard hub hospital stroke center care METHODS Retrospective review of prospectively entered quality performance stroke telestroke patient catalog data were completed for 1000 adult patients who presented with an acute ischemic stroke to the Mayo Clinic Hospitals 500 patients or to one of thirteen Mayo Clinic affiliated telestroke spoke hospitals in the regions 500 patients The primary outcome of interest was the percentage of accurate decision making for eligibility of IV alteplase administration assessed by blinded adjudication and the secondary outcomes pertained to complications discharge parameters and standard quality metrics RESULTS There was no difference in the spoke hospital versus hub hospital groups in identifying and making the correct decision regarding which patients were eligible for IV alteplase administration 96 95 confidence interval CI 94 97 versus 97 95 CI 95 98 P 0 32 There was no difference among the groups in proportion receiving IV alteplase sustaining symptomatic intracranial hemorrhage and mortality Patients in the spoke group were less likely to have a favorable outcome at discharge as defined by National Institutes of Health Stroke Scale NIHSS 0 1 or mRS 0 1 or Glasgow Outcome Scale GOS 0 1 21 versus 35 P Under 0 001 were less likely to have venous thromboembolism prophylaxis 46 versus 63 P Under 0 01 were less likely to have received antithrombotic therapy 85 versus 90 P 02 were less likely to be discharged on anticoagulation when indicated 56 versus 64 P 01 and were less likely to be prescribed cholesterol reducing treatment 68 versus 72 P Under 001 The initial acute care hospital length of stay was longer for the spoke hospital group by one day median 4 versus 3 P Under 001 CONCLUSION The key findings were that evidence based stroke thrombolysis eligibility decision making thrombolysis administration and thrombolysis emergency stroke metrics were uniformly excellent for the spoke hospital group when compared to the standard hub hospital group However evidence based stroke hospitalization and discharge metrics were inferior for the spoke hospital group when compared to the standard hub hospital
- ItemCost utility of hub-and-spoke telestroke networks from societal perspective.(2014-02-11) Demaerschalk, Bart M; Switzer, Jeffrey A; Xie, Jipan; Fan, Liangyi; Villa, Kathleen F; Wu, Eric QA hub and spoke telestroke network is an effective way to extend quality emergency stroke care to remote hospitals and improve patient outcomes
- ItemEmergency Department Telepsychiatry Service Model for a Rural Regional Health System: The First Steps.(0000-00-00) Meyer, James D; McKean, Alastair J S; Blegen, Rebecca N; Demaerschalk, Bart MBACKGROUND Emergency departments EDs have recognized an increasing number of patients presenting with mental health MH concerns This trend imposes greater demands upon EDs already operating at capacity Many ED providers do not feel they are optimally prepared to provide the necessary MH care One consideration in response to this dilemma is to use advanced telemedicine technology for psychiatric consultation INTRODUCTION We examined a rural and community based health system operating 21 EDs none of which has direct access to psychiatric consultation Dedicated beds to MH range from zero in EDs with only 3 beds to 6 in an ED with 38 beds MATERIALS AND METHODS We conducted a needs assessment of this health system This included a survey of emergency room providers with a 67 response rate and site visits to directly observe patient flow and communication with ED staff A visioning workshop provided input from ED staff Data were also obtained which reflected ED admissions for the year 2015 RESULTS The data provide a summary of provider concerns a summary of MH presentations and diagnosis and age groupings The data also provide a time when most MH concerns present to the ED DISCUSSION Based upon these results a proposed model for delivering comprehensive regional emergency telepsychiatry and behavioral health services is proposed CONCLUSIONS Emergency telepsychiatry services may be a tenable solution for addressing the shortage of psychiatric consultation to EDs in light of increasing demand for MH treatment in the ED
- ItemFuture neurohospitalist: teleneurohospitalist.(2013-08-28) Freeman, William David; Barrett, Kevin M; Vatz, Kenneth A; Demaerschalk, Bart MDespite the growing demand for emergency neurological evaluations and neurohospitalists the supply of neurologists remains relatively fixed over time Telemedicine is a unique tool that has the ability to put a medical specialist like a neurologist in 2 places in a relatively short period of time expanding expertise in many rural and in some underserved urban facilities that would ordinarily be devoid of such expertise Teleneurology is a branch of telemedicine that consults and practices through remote neurological evaluation Telestroke is defined as remote stroke evaluation The demand for timely neurological evaluation especially acute stroke evaluation and treatment with intravenous recombinant tissue plasminogen activator IV rtPA continues to fuel the growth of neurohospitalists telestroke and teleneurology services Remote rural or underserved urban emergency departments and hospitals which are unable to successfully recruit a neurologist or neurohospitalist to provide this service are uniquely suited to a teleneurology option The number of private practices and academic centers providing telestroke services has grown significantly in the past decade with continued growth expected We describe the benefits and drawbacks of teleneurology telestroke as well as other practical aspects for the teleneurohospitalist
- ItemA novel application of teleneurology: robotic telepresence in supervision of neurology trainees.(2014-12-23) Kramer, Neha M; Demaerschalk, Bart MAbstract Background Telemedicine is used for specialist consultation patient evaluation and remote monitoring We propose that telemedicine has a valuable role in medical education through facilitating faculty supervision of trainees
- ItemReliability of real-time video smartphone for assessing National Institutes of Health Stroke Scale scores in acute stroke patients.(2012-11-27) Demaerschalk, Bart M; Vegunta, Sravanthi; Vargas, Bert B; Wu, Qing; Channer, Dwight D; Hentz, Joseph GBACKGROUND AND PURPOSE Telestroke reduces acute stroke care disparities between urban stroke centers and rural hospitals Current technologies used to conduct remote patient assessments have high start up costs yet they cannot consistently establish quality timely connections Smartphones can be used for high quality video teleconferencing They are inexpensive and ubiquitous among health care providers We aimed to study the reliability of high quality video teleconferencing using smartphones for conducting the National Institutes of Health Stroke Scale NIHSS METHODS Two vascular neurologists assessed 100 stroke patients with the NIHSS The remote vascular neurologist assessed subjects using smartphone videoconferencing with the assistance of a bedside medical aide The bedside vascular neurologist scored patients contemporaneously Each vascular neurologist was blinded to the other s NIHSS scores We tested the inter method agreement and physician satisfaction with the device RESULTS We demonstrated high total NIHSS score correlation between the methods r 0 949 PUnder0 001 The mean total NIHSS scores for bedside and remote assessments were 7 93 8 10 and 7 28 7 85 with ranges of 0 to 35 and 0 to 37 respectively Eight categories had high agreement level of consciousness questions level of consciousness commands visual fields motor left and right arm and leg and best language Six categories had moderate agreement level of consciousness consciousness best gaze facial palsy sensory dysarthria and extinction inattention Ataxia had poor agreement There was high physician satisfaction with the smartphone CONCLUSIONS Smartphone high quality video teleconferencing is reliable easy to use affordable for telestroke NIHSS administration and has high physician satisfaction
- ItemResponse to letter regarding article, “smartphone teleradiology application is successfully incorporated into a telestroke network environment”.(2013-02-28) Channer, Dwight C; Demaerschalk, Bart M
- ItemRobotic Telepresence Versus Standardly Supervised Stroke Alert Team Assessments.(2014-12-09) O'Carroll, Cumara B; Hentz, Joseph G; Aguilar, Maria I; Demaerschalk, Bart MAbstract Background Telemedicine has created access to emergency stroke care for patients in all communities regardless of geography We hypothesized that there is no difference in speed of assessment between vascular neurologist VN robotic telepresence and standard VN supervised stroke alert patients in a metropolitan primary stroke center Materials and Methods A retrospective stroke alert database was used to identify all robotic telepresence and standardly supervised stroke alert patient assessments at a primary stroke center emergency department from 2009 to 2012 The primary outcome measure was the duration of assessment from stroke alert activation to treatment or downgrade Results The sample size was 196 subjects The mean duration of time from stroke alert activation to initiation of intravenous IV thrombolytic treatment or downgrade was 8 6 min longer in the robotic group than in the standard group p 0 03 Among the subgroup of acute ischemic stroke patients treated with IV thrombolysis the mean duration of time from activation to treatment was 18 min longer in the robotic group than in the standard group p 0 01 Safety outcomes including thrombolysis protocol violations 0 versus 1 post thrombolysis symptomatic intracranial hemorrhagic complications 3 versus 1 and death during hospitalization 8 versus 6 were low in the robotic group and not significantly different from that in the standard group Conclusions Standard VN supervised acute stroke team assessments were swifter than those supervised by robotic telepresence Safety outcomes of robotic telepresence supervised stroke alerts were excellent and this modality may be preferred in circumstances when a VN is not immediately available on site
- ItemSmartphone teleradiology application is successfully incorporated into a telestroke network environment.(2012-10-23) Demaerschalk, Bart M; Vargas, Jason E; Channer, Dwight D; Noble, Brie N; Kiernan, Terri-Ellen J; Gleason, Elizabeth A; Vargas, Bert B; Ingall, Timothy J; Aguilar, Maria I; Dodick, David W; Bobrow, Bentley JBACKGROUND AND PURPOSE ResolutionMD mobile application runs on a Smartphone and affords vascular neurologists access to radiological images of patients with stroke from remote sites in the context of a telemedicine evaluation Although reliability studies using this technology have been conducted in a controlled environment this study is the first to incorporate it into a real world hub and spoke telestroke network The study objective was to assess the level of agreement of brain CT scan interpretation in a telestroke network between hub vascular neurologists using ResolutionMD spoke radiologists using a Picture Archiving and Communications System and independent adjudicators METHODS Fifty three patients with stroke at the spoke hospital consented to receive a telemedicine consultation and participate in a registry Each CT was evaluated by a hub vascular neurologist a spoke radiologist and by blinded telestroke adjudicators and agreement over clinically important radiological features was calculated RESULTS Agreement and 95 CI between hub vascular neurologists using ResolutionMD and 1 the spoke radiologist and 2 independent adjudicators respectively were identification of intracranial hemorrhage 1 0 0 92 1 0 1 0 0 93 1 0 neoplasm 1 0 0 92 1 0 1 0 0 93 1 0 any radiological contraindication to thrombolysis 1 0 0 92 1 0 0 85 0 65 1 0 early ischemic changes 0 62 0 28 0 96 0 58 0 30 0 86 and hyperdense artery sign 0 40 0 01 0 80 0 44 0 06 0 81 CONCLUSIONS CT head interpretations of telestroke network patients by vascular neurologists using ResolutionMD on Smartphones were in excellent agreement with interpretations by spoke radiologists using a Picture Archiving and Communications System and those of independent telestroke adjudicators using a desktop viewer CLINICAL TRIAL REGISTRATION INFORMATION www clinicaltrials gov unique identifier NCT00829361
- ItemSustainable Telemedicine: Designing and Building Infrastructure to Support a Comprehensive Telemedicine Practice.(0000-00-00) Kreofsky, Beth L H; Blegen, R Nicole; Lokken, Troy G; Kapraun, Susan M; Bushman, Matthew S; Demaerschalk, Bart MBACKGROUND Telemedicine services in medical institutions are often developed in isolation of one another and not as part of a comprehensive telemedicine program The Center for Connected Care is the administrative home for a broad range of telehealth services at Mayo Clinic This article speaks of real time video services referenced as telemedicine throughout INTRODUCTION This article discusses how a large healthcare system designed and built the infrastructure to support a comprehensive telemedicine practice MATERIALS AND METHODS Based on analysis of existing services Mayo Clinic developed a multifaceted operational plan that addressed high priority areas and outlined clear roles and responsibilities of the Center for Connected Care and that of the clinical departments The plan set priorities and a direction that would lead to long term success The plan articulated the governing and operational infrastructure necessary to support telemedicine by defining the role of the Center for Connected Care as the owner of core administrative operations and the role of the clinical departments as the owners of clinical telemedicine services Additional opportunities were identified to develop product selection processes implementation services and staffing models that would be applied to ensure successful telemedicine deployment RESULTS The telemedicine team within the Center for Connected Care completed 45 business cases resulting in 54 implementations The standardization of core products along with key operational offerings around implementation services and the establishment of a 24 7 support model resulted in improved provider satisfaction and fewer reported technical issues CONCLUSION The foundation for long term scalability and growth was developed by centralizing operations of telemedicine services implementing sustainable processes employing dedicated qualified personnel and deploying robust products
- ItemSystematic review of teleneurology: neurohospitalist neurology.(2013-10-29) Rubin, Mark N; Wellik, Kay E; Channer, Dwight D; Demaerschalk, Bart MThe use of 2 way audiovisual telemedicine technology for the delivery of acute stroke care is well established in the literature and is a growing practice The use of such technology for neurologic consultation outside the cerebrovascular specialty has been reported to a variable extent across most disciplines within the field of neurology including that of the neurohospitalist medicine A systematic review of these reports is lacking Hence the main purpose of this study was to conduct a systematic review of the literature on teleneurologic consultation in hospital neurology The databases Ovid MEDLINE EMBASE PsychINFO CINAHL and Cochrane were used as data sources and were searched with key words teleneurology and its numerous synonyms and cognates These key words were cross referenced with subspecialties of neurology The studies were included for further review only if the title or the abstract indicated that the study made use of 2 way audiovisual communication to address a neurologic indication This search yielded 6625 abstracts By consensus between the 2 investigators 688 publications met the criteria for inclusion and further review Four of those citations directly pertained to the inpatient hospital neurologic consultation Each of the 4 relevant articles was scored with a novel rubric scoring functionality application technology and evaluation phase A subspecialty category score was calculated by averaging those scores The use of 2 way audiovisual technology for general neurologic consultation of hospital inpatients beyond stroke related care is promising but the evidence supporting its routine use is weak Further studies on reliability validity safety efficacy and cost effectiveness are encouraged
- ItemTeleneurosonology: A Novel Application of Transcranial and Carotid Ultrasound.(2014-12-27) Rubin, Mark N; Barrett, Kevin M; Freeman, W David; Lee Iannotti, Joyce K; Channer, Dwight D; Rabinstein, Alejandro A; Demaerschalk, Bart MTo demonstrate the technical feasibility of interfacing transcranial Doppler TCD and carotid duplex ultrasonography CUS peripherals with telemedicine end points to provide real time spectral waveform and duplex imaging data for remote review and interpretation
- ItemTelestrokologists: treating stroke patients here, there, and everywhere with telemedicine.(2011-01-05) Demaerschalk, Bart MTelemedicine is the use of electronic communication methods such as the telephone the Internet and videoconferencing to exchange medical information from one geographic site to another Telestroke is the use of telemedicine specifically for stroke care A strokologist is a physician with the special skills required for stroke management A telestrokologist is a strokologist who is proficient with telemedicine tools and techniques necessary for remote stroke practice In this article the author discusses how enabling telemedicine technologies facilitate novel healthcare delivery modes for telestrokologists and the stroke patients they treat here there and everywhere
- ItemThe use of telemedicine in the management of acute stroke.(2014-01-01) Rubin, Mark N; Demaerschalk, Bart MCerebrovascular disease including acute ischemic stroke remains a major public health problem in the US and throughout the world There has been a concerted effort to apply evidence based practices to stroke care to improve primary and secondary prevention as well as poststroke outcomes Geography and workforce shortages contribute to a disparity in stroke care however among the substantial proportion of the US population that lives outside the reach of an acute stroke ready hospital or a primary or comprehensive stroke center In an attempt to combat the rural to urban disparity and expand the availability of best stroke practices Levine and Gorman proposed the development of telemedical outreach for acute stroke evaluation and management which they called telestroke Since then the practice of telestroke has been found to have a high interrater agreement with a bedside assessment of the National Institutes of Health Stroke Scale score to enhance correct thrombolysis decision making as compared with telephone only consultation and to be cost effective In light of these findings and the perception of benefit by acute stroke providers and patients there has been growing interest in and a rapid expansion of telestroke networks in the US and internationally There are legal and financial barriers to more widespread use of telemedicine in general including telestroke Further research is needed to understand the potential merits of telestroke infrastructure for the many phases of stroke care including poststroke hospitalization prevention of complications enhancing secondary prevention and education of patients and providers