Telemedical Project for Integrative Stroke Care             in Bavaria, Germany   Conférence Télémédicine et Télésanté en ...
Overview• the need for stroke networks• TEMPiS: key features• TEMPiS: quality data• TEMPiS: outcome analysis• Summary
Overview• the need for stroke networks• TEMPiS: key features• TEMPiS: quality data• TEMPiS: outcome analysis• Summary
Burden of StrokeStrokes in Germany:• 260.000 strokes every year• #3 for death:  40% of the stroke patients die within 1 ye...
Changes in Age Distribution               2000                           2050→ Stroke is a public health challenge of pri...
What to do?  Stroke unit care                               i.v.-Thrombolysis  • reduces death or dependency              ...
Stroke Units in Bavaria, Germany, in 2002The need in 2002 wasto improve stroke carein the underservedareas of Bavaria.    ...
Overview• the need for stroke networks• TEMPiS: key features• TEMPiS: quality data• TEMPiS: outcome analysis• Summary
Key features of the TEMPiS-NetworkImplementation of Stroke        Standard                Training –  wards in each hospit...
1. Stroke WardsImplementation of Stroke Wards  in each network hospital:• stroke wards with  3-6 monitored beds and  ~ 15 ...
2. Standard treatment protocols - SOPsOur TEMPiS-SOPs form our common basis ofmanaging stroke:• TEMPiS-SOPs were developed...
3. Centre based Training   Stroke classes                      Training days for                                speech & s...
3. Onsite training                                    Bedside training for nurses Regular ward roundsin each network hospi...
4. Exchange of ExperienceWard rounds & Meetings                                    Newsletter    www.tempis.de
5. Quality Management Visitation of all network hospitals by the project manager at  least 3 times per year Evaluation o...
6. Teleconsultation - Network Hospital           DSL Academic Stroke Center
6. Stationary workstation – Stroke Center
6. Teleconsultation – mobile solution          works with fast UMTS          = HSDPA (High Speed Downlink Packet Access)
6. Teleconsultations                 Obligatory indication for a teleconsultation:                 • onset of symptoms wit...
Main capabilities of the TEMPiS-NetworkImplementation of Stroke      Standardized              Training –  wards in each h...
Overview• the need for stroke networks• TEMPiS: key features• TEMPiS: quality data• TEMPiS: outcome analysis• Summary
number of teleconsultations per year                                                                                 3.560...
admission to CT-scan: less than 60 minutes100%                2009                    2010                                ...
TEMPiSTeleconsultations since 2003 more than 25.000 teleconsultations currently ~ 360 per monthThrombolysis with rt-PA ...
tele-stroke units vs. conventional stroke units                       Todesfälle                       mortality          ...
Overview• the need for stroke networks• TEMPiS: key features• TEMPiS: quality data• TEMPiS: outcome analysis• Summary
TEMPiS outcome trial• Prospectively obtained data of 3122 stroke patients• Comparing  Outcome of patients treated in netwo...
Poor Outcome after 3 Months           43,0%                          53,4%-10,4%**                     At home with       ...
overview• the need for stroke networks• TEMPiS: key features• TEMPiS: quality data• TEMPiS: outcome analysis• Summary
Take home ...TEMPiS is a regional network based on personal relationship,know-how transfer, quality management and telemed...
AcknowledgementWe thank► all participating stroke neurologists in the stroke centres► all TEMPiS hospitals:  Asklepios Sta...
Thank you for your attention!         Dr. Peter Müller-Barna   Consultant - Coordinator of TEMPiS      Department of Neuro...
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2011-10-21 ASIP Santé Conférence Télémédecine "Présentation TEMPiS"

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Présentation du système de téléconsultation neurologique et de téléradiologie chez des patients atteints d’accident vasculaire cérébral, mis en place par le réseau interhospitalier TEMPiS (Telemedical Project for Integrative Stroke Care)
Docteur MÜLLER-BARNA, Klinikum Harlaching de Munich - TEMPiS

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2011-10-21 ASIP Santé Conférence Télémédecine "Présentation TEMPiS"

  1. 1. Telemedical Project for Integrative Stroke Care in Bavaria, Germany Conférence Télémédicine et Télésanté en Europe FIEEC / ASIP Santé Paris, 21.10.2011 Dr. Peter Müller-Barna Department of Neurology Klinikum Harlaching Städtisches Klinikum München GmbH
  2. 2. Overview• the need for stroke networks• TEMPiS: key features• TEMPiS: quality data• TEMPiS: outcome analysis• Summary
  3. 3. Overview• the need for stroke networks• TEMPiS: key features• TEMPiS: quality data• TEMPiS: outcome analysis• Summary
  4. 4. Burden of StrokeStrokes in Germany:• 260.000 strokes every year• #3 for death: 40% of the stroke patients die within 1 year• #1 for disability: 1 million patients with long-term disability caused by stroke Kolominsky-Rabas, Stroke 1998→ Stroke is a public health challenge of prime importance
  5. 5. Changes in Age Distribution 2000  2050→ Stroke is a public health challenge of prime importance with increasing relevance !!!
  6. 6. What to do? Stroke unit care i.v.-Thrombolysis • reduces death or dependency increases favourable outcome (OR 0.82; 95% CI 0.73 to 0.92; P = 0.001) • OTT 0-90 min NNT 4,5 NNT = 5 (OR 2,55; 95% CI 1,44 to 4,52; P = 0.001) • OTT 90-180 min NNT 9 (OR 1,64; 95% CI 1,12 to 2,40; P = 0.012) • OTT 180-270min NNT 14 (OR 1,34; 95% CI 1,06 to 1,68; P = 0.014) Time is Brain In acute stroke 1.9 million neurons die every minute! Only a minority of all stroke patients in Europe receive stroke unit care Leys, Stroke 2007Cochrane Database of Systematic Reviews 2009 Lees et al., Lancet 2010
  7. 7. Stroke Units in Bavaria, Germany, in 2002The need in 2002 wasto improve stroke carein the underservedareas of Bavaria. Stroke Unit 4 Stroke Center Network-Hospital
  8. 8. Overview• the need for stroke networks• TEMPiS: key features• TEMPiS: quality data• TEMPiS: outcome analysis• Summary
  9. 9. Key features of the TEMPiS-NetworkImplementation of Stroke Standard Training – wards in each hospital treatment protocols center-based and onsiteExchange of Experience Quality Management Teleconsultations
  10. 10. 1. Stroke WardsImplementation of Stroke Wards in each network hospital:• stroke wards with 3-6 monitored beds and ~ 15 additional beds• well defined stroke team consisting of: doctors, nurses, physiotherapists, ergotherapists, speech & swallowing therapists and social workers• (on site) ward round of a neurologist from Monday to Friday• continuous medical training• concept of early rehabilitation
  11. 11. 2. Standard treatment protocols - SOPsOur TEMPiS-SOPs form our common basis ofmanaging stroke:• TEMPiS-SOPs were developed and are updatedyearly in a cooperative effort• with statements for doctors, nurses and therapists• we obligate and control network hospitals to follow the SOPs
  12. 12. 3. Centre based Training Stroke classes Training days for speech & swallowing therapistsStroke Update Sonography Laryngoscopy
  13. 13. 3. Onsite training Bedside training for nurses Regular ward roundsin each network hospital Bedside training for therapists
  14. 14. 4. Exchange of ExperienceWard rounds & Meetings Newsletter www.tempis.de
  15. 15. 5. Quality Management Visitation of all network hospitals by the project manager at least 3 times per year Evaluation of teleconsultations benchmarking of the rate of thrombolysis, the door-to-needle- time, etc. obligatory participation in the German stroke register database documentation and analysis of critical incidences
  16. 16. 6. Teleconsultation - Network Hospital DSL Academic Stroke Center
  17. 17. 6. Stationary workstation – Stroke Center
  18. 18. 6. Teleconsultation – mobile solution works with fast UMTS = HSDPA (High Speed Downlink Packet Access)
  19. 19. 6. Teleconsultations Obligatory indication for a teleconsultation: • onset of symptoms within 4.5 hours • intracranial hemorrhage • impaired consciousness • progressive stroke • brainstem symptoms • NIH-SS  12 • stroke patients aged < 60 yearsA voluntary teleconsultation is possible whenever requested !
  20. 20. Main capabilities of the TEMPiS-NetworkImplementation of Stroke Standardized Training – wards in each hospital treatment protocols center-based and onsiteExchange of Experience Quality Management Teleconsultations TEMPiS is based on personal relationship, know-how transfer, quality management and telemedicine ► TEMPiS is a regional network with limited size
  21. 21. Overview• the need for stroke networks• TEMPiS: key features• TEMPiS: quality data• TEMPiS: outcome analysis• Summary
  22. 22. number of teleconsultations per year 3.560 3.216 3.187 3.0623.000 2.859 2.837 2.6882.000 1.9241.000 0 2003 2004 2005 2006 2007 2008 2009 2010 Source : TEMPiS-database of teleconsultations
  23. 23. admission to CT-scan: less than 60 minutes100% 2009 2010 96% 94% 93% 92% 91% 91%90% 87% 88% 88% 88% 87% 85% 85% 81% 80%80% 76%70% 67%60% Bad Tölz Traunst. TEMPiS BAQ Dachau Ebersb. Rosenh. Eggenf. Mühldorf Pasing Burgl`feld Freising Straubing Landshut Cham Kelheim Zwiesel Source: BAQ
  24. 24. TEMPiSTeleconsultations since 2003 more than 25.000 teleconsultations currently ~ 360 per monthThrombolysis with rt-PA since 2003 about 2.300 thrombolysis currently ~ 45 per month~ 6.500 strokes per year in the 15 regionalnetwork hospitals (extra 1.800 strokes in the strokecentres Harlaching and Regensburg)
  25. 25. tele-stroke units vs. conventional stroke units Todesfälle mortality TEMPiS-Kooperationskliniken (15) Pneumonierate BAQ gesamt (80 Kliniken) rate of pneumonia door toto needletime Door needle time Frühzeitige Thrombolyse early thrombolysis Antikoagulation bei in AF anticoagulation VHFli antiplatelet drugsbei discharge TAH at Entlassung TAH innerhalb 48h antiplatelet drugs at 48h carotid Gefäßdiagnostik duplex or CTA Bildgebung CT scan Logopädie early speech therapy Screening nach for dysphagia screening Schluckstörung Mobilisierung early mobilisation Physiotherpie / Ergotherapie early physiotherapyInformation Patient und Angehörige information for patient/relatives 0% 20% 40% 60% 80% 100% Source: BAQ; analysis for 2010
  26. 26. Overview• the need for stroke networks• TEMPiS: key features• TEMPiS: quality data• TEMPiS: outcome analysis• Summary
  27. 27. TEMPiS outcome trial• Prospectively obtained data of 3122 stroke patients• Comparing Outcome of patients treated in network hospitals to Outcome of patients treated in control hospitals• poor Outcome dead or institutional care or at home with severe disability Lancet Neurol 2006; 5: 742–48
  28. 28. Poor Outcome after 3 Months 43,0% 53,4%-10,4%** At home with 14,3% 21% severe disability 12,5% Institutional 14,2% Care 16,2% Dead 18,1% TEMPiS Control hospitals Lancet Neurol 2006; 5: 742–48
  29. 29. overview• the need for stroke networks• TEMPiS: key features• TEMPiS: quality data• TEMPiS: outcome analysis• Summary
  30. 30. Take home ...TEMPiS is a regional network based on personal relationship,know-how transfer, quality management and telemedicine.Stroke care within this kind of network improves the prognosisof stroke patients. Telestroke is part of routine stroke care in Bavaria.
  31. 31. AcknowledgementWe thank► all participating stroke neurologists in the stroke centres► all TEMPiS hospitals: Asklepios Stadtklinik Bad Tölz Kreiskrankenhaus Kelheim Kreisklinik Bad Reichenhall Kreisklinik Mühldorf Asklepios Klinik Burglengenfeld Klinik München-Pasing Kreisklinik Cham Klinikum Rosenheim Klinikum Dachau Klinikum St. Elisabeth Straubing Kreisklinik Ebersberg Klinikum Traunstein Kreisklinik Eggenfelden Krankenhaus Zwiesel Klinikum Freising
  32. 32. Thank you for your attention! Dr. Peter Müller-Barna Consultant - Coordinator of TEMPiS Department of Neurology and Neurologic Intensive Care Städtisches Klinikum München GmbH Klinikum Harlaching Sanatoriumsplatz 2 - 81545 München Tel. 089 6210 2259E-Mail: peter.mueller-barna@klinikum-muenchen.de www.tempis.de
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