In a journal article published by the American Heart Association and the American Stroke Association, researchers highlighted the potential for a new app to help emergency medical services (EMS) make efficient transport decisions in competitive markets.
The Fast-ED app considers patient condition, the JC certifications of local stroke programs, and traffic patterns to recommend a destination that strikes the right balance between proximity and specialization.
To make sense of this emerging technology, we've provided answers to top questions about the app and its potential implications for your stroke program.
How are transport decisions made now?
About half of all states have regulations dictating stroke transport, usually prioritizing longer transport to JC-certified centers. Regulations in Los Angeles County, for instance, mandate EMS take high-severity patients to the nearest Comprehensive Stroke Center (CSC)—but only if it's less than 30 minutes away. In regions with these regulations, certification is an important contributor to stroke volumes.
For states without regulations, transport is largely determined by EMS' judgement of patient severity and the quality of nearby stroke programs. In Utah, a state without stroke transport regulations, only 15% of responders bypass closer hospitals to bring patients to more advanced facilities. In these regions, planners have traditionally prioritized marketing and strong EMS relationships in order to grow stroke volumes.
How does this new app work?
The app gives EMS a recommendation as to whether the patient's condition warrants bypassing closer, less-specialized hospitals.
To do so, the app uses a series of guided questions to calculate a stroke triage score based on the patient's symptoms, when they began, and their severity. If the score indicates the need for advanced treatment, the app analyzes traffic data to determine whether increased transport time to a JC-certified specialized hospital is warranted—specifically, to CSCs—which are indicated for the severest of patients—Primary Stroke Centers, and Acute Stroke-Ready Hospitals.
How will this impact stroke programs?
These apps reflect that there is a growing body of literature that favor further transport to specialized facilities for severe stroke patients. Planners who already offer or intend to offer specialized procedures should consider pursuing a formal certification, as this could become a key contributor to future volumes—even outside of states that regulate transport to such facilities. And providers who have CSC certification could see new volumes—perhaps from more distant regions.
Hospitals that aren't JC certified in this field should consider partnership opportunities with larger certified stroke programs. Select institutions have pursued a hub-and-spoke model, using telestroke technology to connect high-severity patients at smaller hospitals with the advanced resources of the hub.
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