Integrating Health Care and Academia: Partnership for Change

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This was presented in session B4 at the Quality Forum 2014 by:

John Falconer
Neurologist
TIA/Stroke Clinic
Interior Health
Clinical Assistant Professor, Neurology
UBC

Published in: Health & Medicine
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Integrating Health Care and Academia: Partnership for Change

  1. 1. "Mobile" TeleStroke
  2. 2. STROKE - 50,000 strokes in Canada each year - Stroke is the third leading cause of death in Canada. - Stroke costs the Canadian economy $3.6 billion a year in physician services, hospital costs, lost wages, and decreased productivity
  3. 3. TPA - Clot Busting Drug • Right kind of Stroke • CT Scan • Neurologist Consultation 3 to 4 Hours for "Clot Busting Drug"
  4. 4. TPA Benefit • ~ 10% stroke patients suitable • 1/3 Appropriate Patients Benefit • Sometimes Miraculous • Some dying, 20 minutes later ~ normal • Some dense hemiplegia, next day mild weakness only
  5. 5. IHA - UBC Mobile Telestroke Pilot Study • Kelowna Neurologists all supplied with iPads; can see and talk with patient • 5 Referring Hospital ER's supplied with iPads
  6. 6. IHA - UBC Mobile Telestroke Pilot Study • Stroke Patient arrives in ER, option to have Video-Conference with Kelowna Neurologist • TPA or non-TPA Stroke patient eligible • Pilot over 6 months
  7. 7. Kelowna Neurology Castlegar Patient Trail CT
  8. 8. Face Time
  9. 9. $25,000 $25,000 Current "Telehealth" $800 $800 IHA Mobile Telestroke
  10. 10. Connection KGHN -> LERD/Patient vs. C E L L U L A R
  11. 11. Hospital/ Outside C E L L U L A R Home or Office
  12. 12. Data Collection: Date Hospital MD’s Patient KGHN Hear & See Satisfied Improved Neurologist Need Care User Friendly Satisfied Process Improved Need To Changed Care Consult Care LEDP User Friendly MediTech ID Age Gender Weight Kg Satisfied Process Improved Need To Changed Care Consult Care NIHSS E H Admit S Time Arrival CT Time Transferred FaceTime FaceTime V-C to another V-C call call Duration Hospital Time
  13. 13. MediTech ID Age Gender Weight Kg 63 Anonymous Tracking N/A M=F NIHSS EHS Admit Time Arrival CT Time Transferred FaceTime FaceTime V-C to another V-C call call Duration Hospital Time
  14. 14. MediTech ID Age Gender Weight Kg NIHSS EHS Admit Time Arrival 4/5 4.64 4/5 CT Time Transferred FaceTime FaceTime V-C to another V-C call call Duration Hospital Time
  15. 15. MediTech ID Age Gender Weight Kg NIHSS EHS Admit Time Arrival CT Time Transferred FaceTime FaceTime V-C to another V-C call call Duration Hospital Time 11:11 9:49 4/25
  16. 16. MediTech ID Age Gender Weight Kg NIHSS EHS Admit Time Arrival CT Time Transferred FaceTime FaceTime V-C to another V-C call call Duration Hospital Time 6.8 min 9:49 10:58
  17. 17. Rural Hospitals Connected With – 86% CT Enabled Trail Vernon Nelson Creston Grand Forks Cranbrook
  18. 18. Neurologists Using Face Time WL JF SM DC DA 14 7 4 0 0
  19. 19. Neurologists Using Face Time - Those who didn’t… 14 o My iPad wasn’t charged o It was 3:00 am o No appropriate call forgot it at home 7 4 0 0
  20. 20. Rural Mobile Telestroke Pilot Patient Hear & See Satisfied Improved Neurologist Need Care 1.4 1.4 1.4 LEDP User Friendly KGHN Satisfied Process Improved Need To Changed Care Consult Care User Friendly 1.36 1.4 1.4 Satisfied Process Improved Need To Changed Care Consult Care 1.4 1.44 1.4 Strongly Agree(1) | Agree (2) | Neutral (3) | Disagree (4) | Strongly Disagree (5)
  21. 21. Rural Mobile Telestroke Pilot Patient Hear & See Satisfied Improved Neurologist Need Care 1.4 1.4 1.4 LEDP User Friendly KGHN Satisfied Process Improved Need To Changed Care Consult Care User Friendly 1.36 1.4 1.4 Satisfied Process Improved Need To Changed Care Consult Care 1.4 1.44 1.4 Strongly Agree(1) | Agree (2) | Neutral (3) | Disagree (4) | Strongly Disagree (5)
  22. 22. Rural Mobile Telestroke Pilot Patient Hear & See Satisfied Improved Neurologist Need Care 1.4 1.4 1.4 LEDP User Friendly 1.4 KGHN Satisfied Process Improved Need To Changed Care Consult Care User Friendly Satisfied Process Improved Need To Changed Care Consult Care Changed Care: 23/25 1.4 1.4 1.36 1.4 1.44 Strongly Agree(1) | Agree (2) | Neutral (3) | Disagree (4) | Strongly Disagree (5)
  23. 23. Rural Mobile Telestroke – they liked it, but did it matter? More Accurate Dx Used TPA Avoid TPA Transfer Stroke Mimic No Change
  24. 24. Accuracy of Diagnosis
  25. 25. Enabled TPA
  26. 26. Avoided TPA
  27. 27. Stroke Mimic
  28. 28. Conclusion:
  29. 29. Conclusion: 1. iPad is a feasible Telehealth Device 2. Used infrequently; High Value when Used 3. Neurologist Driven 4. WiFi Security hampers V-C 5. Cellular V-C effective
  30. 30. Interior Health Authority "Mobile" Telestroke IHA MedIT Leads the Province In facilitating eHealth Thank you to IHA: • Dr. Robert Halpenny • Mal Griffin CIO • Many others
  31. 31. "Mobile" TeleStroke

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