The VINNOVA-funded project PreHospIT Stroke was begun just over a year ago. Participating in it are several institutions together with medical-technical companies, ambulance organisations, Västra Götalands’s IT department, and other regions. The main purpose of the project is to improve the chain of care for strokes with the help of IT solutions in ambulance care. The project’s expert researcher in ambulance care is Magnus Hagiwara from PreHospen at the University of Borås.
– During the past year, those in the project group have done an enormous amount of preparatory work, he says. To create a system that works, we have to, for example, harmonise the terminologies used in all the systems involved so that they can speak with each other and understand information in the same way. It is a big and complicated job in which the different record-keeping systems and types of decision support are included and in which several different laws, such as regarding privacy and such matters, are involved.
Simulated cases of stroke are tested in different environments
This spring, a simulation test with the different involved systems will be performed so that we can see if the infrastructure works and if the information is received and dealt with as it should be. For that, Magnus Hagiwara has created four scenarios with different types of simulated cases of stroke in different environments. Through these, different variations in the chain of care will be highlighted when the systems are tested.
– We are going to divide the stroke chain of care into different phases and define what is included in each phase and what type of support can be needed in order for assessment and treatment to be correct. It can have to do with what is needed for the dispatch centre to be able to class the patient as a stroke patient, for the ambulance to find its way to the patient, and to facilitate the medical caregiver’s assessment of the patient.
– There can perhaps be a need to have all documentation gathered together in only one system? And perhaps videoconferences with a neurologist or the possibility to send pictures of the patient to facilitate the assessment?
Generally, ambulance personnel need better IT support and more IT-based systems as their work becomes ever more complex. When it comes to stroke patients, ambulance nurses are now expected not just to make the diagnosis of stroke, but also to determine which type of stroke, as different treatments are relevant for different types of stroke.
After this spring’s simulation tests, when the different IT systems are to be tested and fine-tuned, Magnus Hagiwara will participate in the design of a clinical study starting in Gothenburg this autumn.
– Much is yet to be determined, as we don’t yet know which IT supports and systems will be used, he says. We also don’t yet know how many ambulances can participate. Another uncertainty regards which systems we can actually use in practical terms in which the technologies work with sufficiently high quality.
In the study, several ambulances will have the equipment that has been developed. Other ambulances and ambulance stations will function as a control group.
Hoping to shorten the time to receive treatment
Another element that will be investigated is whether IT supports shorten the time it takes for stroke patients to receive treatment with thrombolysis or thrombectomy (i.e. treatment with thrombolytic drugs or the surgical removal of blood clots).
– It is a very complex study and we have not yet determined how many patients are required to achieve clear, scientifically sound results. But I believe that we will need to extend the time for the study, which according to our original plans should be completed in the spring of 2017.
The systems that will be tested will even be transferable to other patient groups, such as trauma, hip fracture, and heart attack.
Magnus Hagiwara’s expectations with PreHospIT Stroke are that it will lead to a more convenient and smooth process around stroke patients within ambulance care and that the time to correct treatment will be shortened.
– I believe absolutely that the work process can be improved, but it remains to be seen if there is an effect for the patient and time to receive care, he says.