Acute Ischemic Stroke, Ischemic Stroke
Conditions
Keywords
telemedicine, virtual care
Brief summary
The goal of this clinical trial is to determine if patients admitted to a primary stroke centre, such as the general internal medicine service of the Ottawa Hospitals General Campus, for acute ischemic stroke would benefit from a scheduled virtual assessment with a stroke neurologist to review investigations, results, and evaluations to identify stroke etiology, propose appropriate therapy, and guide decision-making and multidisciplinary assessment, similar to services provided to patients admitted to comprehensive stroke centres, such as the Civic Campus of the Ottawa Hospital.
Detailed description
Patients admitted to primary stroke centres do not have access to the same level of stroke expertise on site as do patients admitted to comprehensive stroke centres, resulting in increased length of stay with implications for access to stroke rehabilitation. Virtual access to stroke experts has been used in hyperacute stroke care through programs such as Ontario Telestroke, but this has not been routinely used for acute inpatient management. The investigators propose a system to provide virtual access to the stroke neurology team to patients admitted with stroke in a primary stroke centre. Patients at the General Campus of the Ottawa Hospital are currently admitted to Internal Medicine; this includes scheduled virtual assessment with a stroke neurologist and advanced practice nurse/interdisciplinary support to review investigations, results, and evaluations to identify stroke etiology, propose appropriate therapy, and guide decision-making and multidisciplinary assessment, similar to services provided to patients admitted to the Civic Campus. This will be developed with the assistance of Internal Medicine and will utilize technologies and assessment tools and strategies already being used for provision of virtual care in other settings. The goal of this project will be to prove that patients in primary stroke centres, with the assistance of virtual care, can benefit from the expertise available at comprehensive centers throughout their stay, and that this will result in an improved quality of care with benefits for patients, hospitals, and the community.
Interventions
OTHERVirtual assessment
virtual assessment with a stroke neurologist/advanced practice nurse, with interdisciplinary support, to facilitate the care of patients admitted to primary stroke centres using existing tools for remote evaluation and review.
Sponsors
The Ottawa Hospital Academic Medical Association
Ottawa Hospital Research Institute
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 18 years of age or older * admitted to the general internal medicine service of the Ottawa Hospital General Campus for acute ischemic stroke * able to participate in video assessments with necessary accommodation/facilitation for participation (particularly if stroke results in physical or communication deficits)
Exclusion criteria
* patients who are unable, in the judgement of the study team or treating team, to participate in video assessments
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Morbidity-adjusted length of stay | Through study completion, an average of 6 months | Number of days admitted to general internal medicine |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of time on ALC | Through study completion, an average of 6 months | Length of time on alternate level of care |
Other
| Measure | Time frame | Description |
|---|---|---|
| Discharge destination | Over 6 months | The classification of where a patient is sent on completion of their hospital admission (i.e. home vs. rehabilitation vs. other facility vs. death) |
| Functional outcome | Over 6 months | modified Rankin Score 0-6 (0 is no symptoms at all, and 6 is death) |
| Home time | Over 6 months | patient-centered metric examining time spent at home after discharge from hospital/rehabilitation at 6 months |
Outcome results
None listed