title: Stop Stroke: A Brief Report on Door-to-Needle Times and Performance After Implementing an Acute Care Coordination Medical Application and Implications to Emergency Medical Services.
abstract: OBJECTIVE
  The objective of this study was to evaluate the effect of the Stop Stroke (Pulsara; Bozeman, Montana USA) medical application on door-to-needle (DTN) time in patients presenting to the emergency department (ED) with an acute ischemic stroke (AIS).
  
  
  METHODS
  This was a retrospective cohort study of the Good Shepherd Health System (Longview, Texas USA) stroke quality improvement dashboard for a 25-month period from February 2012 through February 2014. Data analysis includes all data from Center for Medicare and Medicaid Services (CMS; Baltimore, Maryland USA) reportable cases receiving Tissue Plasminogen Activator (TPA) for AIS during the study period. The primary outcome was mean DTN times before and after initiating Stop Stroke. Secondary outcome was the effect on the DTN≤60-minute benchmark.
  
  
  RESULTS
  During the study period, there were 533 stroke activations (200 before Stop Stroke implementation and 333 after). A total of 68 patients meeting inclusion criteria were analyzed (34 pre-app and 34 post- app). The observed mean DTN times post-app decreased 21 minutes (77 to 56 minutes), a 28% improvement (P=.001). Further, the patients meeting DTN≤60 minutes improved from 32% (11 of 34) to 82% (28 of 34) after the app's implementation.
  
  
  CONCLUSIONS
  In this cohort of patients with AIS, Stop Stroke improved mean DTN times and number of patients treated within 60 minutes of arrival. These results demonstrate the app's effect of increasing awareness of suspected AIS and improving coordination of care, evidenced by the magnitude of its effect on treatment times. Dickson R , Nedelcut A , McPeek Nedelcut M . Stop Stroke: a brief report on door-to-needle times and performance after implementing an acute care coordination medical application and implications to Emergency Medical Services. Prehosp Disaster Med. 2017;32(3):343-347.
authors.affiliation: 1Baylor College of Medicine,Houston,TexasUSA.
authors.forename: Robert
authors.initials: R
authors.lastname: Dickson
authors.affiliation: 2University of Texas,Tyler,TexasUSA.
authors.forename: Adrian
authors.initials: A
authors.lastname: Nedelcut
authors.affiliation: 2University of Texas,Tyler,TexasUSA.
authors.forename: Melissa McPeek
authors.initials: MM
authors.lastname: Nedelcut
mesh_terms: D019985:Benchmarking; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D006801:Humans; D015397:Program Evaluation; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D013781:Texas; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D010959:Tissue Plasminogen Activator
keywords:  AIS acute ischemic stroke;  CMS Center for Medicare and Medicaid Services;  DTN door-to-needle;  ED emergency department;  EMS Emergency Medical Services;  OTT onset-to-treatment;  TPA Tissue Plasminogen Activator; acute care coordination; mobile technology; stroke; therapy