Gutiérrez-Zúñiga Raquel, Uclés Jorge, Sánchez-Manso Juan Carlos, Fuentes Blanca, de Celis Elena, Ruiz-Ares Gerardo, Rodríguez-Pardo Jorge, Rigual Ricardo, Casado Laura, Alonso Elisa, Fernández-Prieto Andrés, Navia Pedro, Álvarez-Muelas Alberto, Marín Begoña, Díez Tejedor Exuperio, Alonso de Leciñana María
Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain.
Section of Neuroradiology, Department of Radiology, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain.
Digit Health. 2022 Nov 15;8:20552076221137252. doi: 10.1177/20552076221137252. eCollection 2022 Jan-Dec.
Timely coordination between stroke team members is of relevance for stroke code management. We explore the feasibility and potential utility of a smartphone application for clinical and neuroimaging data sharing for improving workflow metrics of stroke code pathways, and professionals' opinions about its use.
We performed an observational pilot study including stroke code activations at La Paz University Hospital in Madrid, from June 2019 to March 2020. Patients were classified according to the activation or not of the JOIN app by the attending physician. Clinical data and time-to-procedures were retrieved from the app or from the hospital records and the Madrid regional stroke registry as appropriate and compared between both groups. An anonymous survey collected professionals' opinions about the app and its use.
A total of 282 stroke code activations were registered. The JOIN app was activated in 111 (39%) cases. They had a significant reduction in imaging-to-thrombolysis (31 vs 20 min, p = .026) and in door-to-thrombolysis times (51 vs 36 min, p = .004), with more patients achieving a door-to-needle time below 45 min (68.8% vs 37.8%, p = .016). About 50% of the users found the app useful for facilitating the diagnosis and decision-making; interoperability with clinical files was considered an opportunity for improvement.
This pilot study suggests that JOIN helps improve and document workflow metrics in acute stroke management in a comprehensive stroke centre. These results support testing JOIN in a prospective randomised study to confirm its usefulness and the general applicability of the results.
卒中团队成员之间的及时协调对于卒中代码管理至关重要。我们探讨了一款智能手机应用程序用于临床和神经影像数据共享以改善卒中代码流程工作指标的可行性和潜在效用，以及专业人员对其使用的看法。
我们进行了一项观察性试点研究，纳入了2019年6月至2020年3月在马德里拉巴斯大学医院激活的卒中代码病例。根据主治医生是否激活JOIN应用程序对患者进行分类。临床数据和治疗时间从应用程序或医院记录以及马德里地区卒中登记处酌情获取，并在两组之间进行比较。一项匿名调查收集了专业人员对该应用程序及其使用的看法。
共记录了282次卒中代码激活。JOIN应用程序在111例（39%）病例中被激活。这些病例的影像检查至溶栓时间（31分钟对20分钟，p = 0.026）和门到溶栓时间（51分钟对36分钟，p = 0.004）显著缩短，更多患者实现了门到针时间低于45分钟（68.8%对37.8%，p = 0.016）。约50%的用户认为该应用程序有助于促进诊断和决策制定；与临床文件的互操作性被认为有改进的空间。
这项试点研究表明，JOIN有助于改善和记录综合卒中中心急性卒中管理中的工作流程指标。这些结果支持在前瞻性随机研究中对JOIN进行测试，以确认其有用性和结果的普遍适用性。
