Purpose
In stroke, time and choice of treatment are critical. In ischemic stroke current options are thrombolysis or thrombectomy, with the latter as preferred choice in LVO (Large Vessel Occlusion)– but also only available at selected hospitals. If direct transport in suspected LVO can be decided with good precision in the ambulance, valuable time to treatment can be saved. Today this decision is far from obvious. Phone calls to stroke consultants and/or prehospital assessment scales are what´s commonly available. However, these introduce a risk of uncertainty and unfamiliarity in the assessments. With ViPHS (Video support in PreHospital Care) the purpose is to propose and test a telemedicine solution utilizing video streaming to increase precision in prehospital decisions regarding LVO cases. The paper presents the bearing clinical as well as technical principles and arguments in ViPHS, together with experiences gained from realistic full scale simulations and operational clinical pilots.
Method
The project followed a clinical process innovation model developed by the project team. This four-step model involves analysis of present care processes and proposals regarding alternative care process and technology, stepwise prototyping leading into full-scale realistic simulations, and finally a limited and an extended pilot.
Results
ViPHS has been tested in simulations and pilots. The results show that streamed video in the ViPHS telemedicine care model enables stroke experts to remotely make neurological assessments according to the NIHSS (National Institute of Health Stroke Scale) protocol.
Conclusions
Streamed video and remote NIHSS assessment using ViPHS care model can contribute to shortening vital time to thrombectomy through more informed transport and care decisions for suspected LVO cases. The remote NIHSS assessment can also shorten time for other patients on arrival to any hospital with stroke handling capabilities like thrombolysis. Therefore, ViPHS constitutes an important addition to present acute regional stroke care. ViPHS may also be deployed outside ambulance settings, for instance at smaller care facilities, but also in non-stroke applications if customized care processes and on-call routines are designed accordingly.