Health networks for the treatment of stroke

Transcription

1 Boundaryless Hospital in Health Care Networks Health networks for the treatment of stroke Matthias Endres, M.D. Professor and Chair Dept Neurology Charité Center for Stroke Research Berlin

2 Stroke ca strokes/year (Germany) No 3. cause of death 20(-40) % Mortality % Morbidity and Mortality No 1. cause of disability (adulthood) Direct plus indirect cost p.a. > 10 Billion Euro

3 Stroke other 2% SAH 5% ICH 10% Ischemic stroke 83%

4 Acute therapy of stroke Thrombolysis Aspirin Stroke Unit Hemicraniektomy

5 Schleswig-Holstein Mecklenburg-Vorpommern Hamburg Bremen Nordrhein-Westfalen Niedersachsen Sachsen-Anhalt Berlin Brandenburg 231 certified Stroke Units Quelle: Stiftung Deutsche Schlaganfall-Hilfe Karte erstellt mit RegioGraph 8, Kartengrundlage GfK MACON GmbH Sachsen Thüringen Hessen Rheinland-Pfalz Saarland Baden-Württemberg Bayern

6 Stroke Center TeleStroke Tele-stroke Community hospital DSL DICOM

7 TeleStroke TeleStroke Units in Bavaria 100 % coverage 4

8 TeleStroke

9 Center for Stroke Research Berlin An integrated center for research and treatment

10 Guiding principles: 1. Bench to bedside to bench 2. Stroke as a chronic disease

11 Challenge fragmentation of health care blackbox aftercare treatment often uncoordinated and inefficient gap gap gap treatment?

12 StrokeNet Telemedicine support for pre-hospital stroke care

13 tpa effect is time dependent

14 StrokeNet-Project CCM CBF

15 Stroke 2013

16 Achievements Implementation of videoconferencing techniques in ambulance cars Technological feasibility Integration in Charité IT-network Barriers Data security and labour legislation Technological stability Reluctance by ambulance crews

17 STEMO The STroke Emergeny MObile

18

19 ~ emergency calls/year ~ emergency transports/year ~ stroke patients via EMS (2,7%)

20

21 JAMA 2014

22 STEMO treatment resulted in 50% higher thrombolysis rates (33% vs. 21%) STEMO treatment war 28 min faster (48 min vs. 76 min) JAMA 2014

23 Can we target the Golden Hour'? Alarm to needle times compared to regular care Thrombolysis Thrombolysis rates rates (%) (%) 4,5 44 3,5 33 2,5 22 1,5 11 0,5 00 STEMO Berlin SITS-MOST Minutes

24 Challenge fragmentation of health care blackbox aftercare treatment often uncoordinated and inefficient gap gap gap treatment?

25 SOPs and treatment paths SOPs Symptombeginn < 6 Stunden oder unklar P Resources Verfügbarkeit Neurologe auf RS Guidelines Documentation requirements System / Form / Content of Documentation Campus-specific Variation Stroke Alarm "neurologischer Notfall" P Multiprofessional 3 min IT-Support Consistent Standards Benachrichtigung (Neuro-)Radiologe MTRA, SU, Labor Neurologe vor Ort auf Rettungsstelle Übergabe Patient durch Pflege an Neurologen Multi disciplinary N 5 min Pfadaustritt Neurologie / Neurochirurgie Kriterien Notfalllabor Time line Interface Aufklärung Patient SLAs with cooperating Departments Documentation requirements Standard Interfaces Siemens Healthcare Consulting

26 Stroke Pathway from definition to Hospital Information System 1 Translation of the Master Path into Workflow 2 Providing the Workflow for Patient Care

27 Regular stroke reports (monthly)

28 Technical aspects Neurologist at the ED. Charité-Intranet Internet 1 external provider MIS SAP (ish*med) e-gate (Interconnection) Filter-Server 1 Neurologist on call fills in the Special Stroke Sheet 2 Medical information system make data available for interconnect. 3 Retrieves date (Poll every 10 minutes) 4 5 Web-Service provides anonymous data Sends SMS Content: OU / Gender / Age / Date and time of admission / NIHSS service schedule who, when doctor in charge at home

29 Stroke Trial Patients Recognized by Alarm on Mobile Phone. Site Gender Age Date and time of admission NIHSS-Score

30 BSA The Berlin Stroke Alliance

31 Challenge fragmentation of health care blackbox aftercare treatment often uncoordinated and inefficient gap gap treatment?

32 The CSB has founded the Berlin Stroke Alliance covering the majority of the service providers for stroke patients in Berlin. Berlin Stroke Alliance

33 BSA members 17 stroke units 17 rehabilitation facilities 12 aftercare facilities & 4 associated members (e.g. self-help organisation) estab. 2008

34 Key Achievements

35 Stroke Service Point

36 Recently the CSB started a large information campaign. Under the auspices of Klaus Wowereit, Mayor of Berlin Main Players

37 Berlin gegen den Schlaganfall Following the 6 month campain the number of stroke patients admitted via emergency medical services increased by 10%, i.e. from 63% to 73% Heuschmann, Endres, submitted

38 Tempis Center for Stroke Research Berlin Trial Team Stroke Net STEMO Berlin Stroke Alliance

39 Vision for the hospital of the future Academic / medical leadership Health care oriented towards and supported by research Regional health care networks with integrated care intelligent IT, electronic medical records, telemedicine IT and controlling should improve patient care and not vice versa