Original ResearchBrain Emergency Management Initiative for Optimizing Hub–Helicopter Emergency Medical Systems–Spoke Transfer Networks
Section snippets
Methods
We conducted an exploratory, retrospective assessment of prospective data on consecutive acute telestroke evaluations in which transfer was initiated for embolectomy in 2 time periods (pre-BEMI: October 13, 2013-June 13, 2016 vs. BEMI: June 13, 2016-October 29, 2017). The institutional review board approved this as a quality improvement initiative (institutional review board #171923). A chart review completed by a single vascular neurologist compared characteristics, times, discharge
Results
One hundred forty-eight telestroke transfers were assessed. Exclusions included 64 nonurgent transfers, 9 ground transports, 5 inpatient codes, and 2 transfers with incomplete data. The final analysis included 68 patients (32 pre-BEMI and 36 BEMI). Baseline comparisons showed no difference for age, sex, diabetes, hypertension, or atrial fibrillation (Table 1). The National Institute of Health Stroke Scale (NIHSS) was used as a measure of stroke severity because increasing scores represent
Discussion
With extended stroke windows, optimized pathways for transfer are needed.3, 4, 5, 6, 7, 8, 9 Historically, spoke transfer processes have been complicated. The cardiac landscape has encouraged short DIDO and door to groin puncture times.11,13, 14, 15 BEMI implementations coupled with HEMS optimizations and hub rapid acceptance and assessment protocols may improve stroke care because it has been shown that reduced time to treatment improves patient outcomes.12 We sought to do a comparison of 2
Conclusion
This pre-BEMI versus BEMI analysis found that spoke-side BEMI transfer initiatives coupled with a STEMI-like shift in HEMS culture and hub-side rapid acceptance and assessment protocols resulted in improved evaluation and treatment times. With the advent of more embolectomy efficacy evidence, BEMI could add to the current literature and serve as a model of rapid stroke transfer pathways as well as future telestroke quality measures. Work in a larger data set to further confirm the
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Cited by (4)
(VISIION-S): Viz.ai Implementation of Stroke augmented Intelligence and communications platform to improve Indicators and Outcomes for a comprehensive stroke center and Network – Sustainability
2023, Journal of Stroke and Cerebrovascular DiseasesTelestroke Across the Continuum of Care: Lessons from the COVID-19 Pandemic
2021, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Telestroke contributes to the identification and assessment of patients with syndromes or imaging concerning for LVO, via remote imaging review and planning for transfer to endovascular-capable centers.27 Rapid interfacility transfer programs have been developed to optimize transfer times in stroke emergencies.28 Traditional hub and spoke models of telestroke support the retention of patients with mild stroke syndromes or stroke mimics in their local hospitals by providing guidance for initial stroke management and hospitalization.
A Stroke Care Model at an Academic, Comprehensive Stroke Center During the 2020 COVID-19 Pandemic
2020, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :A plan should be devised in each region to expedite stroke transfers among institutions. Tele-stroke cases identified as having 1) large vessel occlusion and favorable profile or 2) requiring increased level of care are transferred via the Brain Emergency Management Initiative (BEMI) rapid transfer protocol.10 All transfer patients are considered COVID-19 screen positive to maximize safety and reduce the risk of transmission to the multiple parties involved in patient transfers.
Dr. Modir received a Medtronic honorarium, Dr. B. Meyer received a grant from National Institute of Neurological Disorders and Stroke (grant no. U24NS107225), Dr. D. Meyer is a speaker for Chiesi and Portola, and Dr. Mukau is a speaker for Medtronic.