Less Experienced Telestroke Consultants Are More Likely to Go On-Camera, but Less Likely to Give tPA.
Less Experienced Telestroke Consultants Are More Likely to Go On-Camera, but Less Likely to Give tPA.
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经验较少的远程中风顾问更有可能出现在镜头前，但不太可能提供 tPA。
DOI：
10.1155/2019/1059369
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发表时间：
2019
影响因子：
1.5
通讯作者：
Chauhan,Nabeel
中科院分区：
文献类型：
--
作者：
deHavenon,Adam;Chung,LeeS;Smith,Jaleen;Taylor,Kirby;Majersik,JenniferJ;Chauhan,Nabeel
背景中风远程医疗（远程中风）增加tPA的可用性和管理。然而，有效地使用遥划需要培训，这不是血管神经病学培训的标准组成部分。因此，许多提供者在完成培训后“在工作中”学习电传打字技能。目标。我们试图探讨，如果供应商有更多的远程中风的经验将更有效地利用远程医疗，相比供应商经验较少。我们前瞻性地收集了2014年7月至2017年7月期间综合卒中中心的远程卒中数据。电话试探是在电话上发起的，通常但不总是，随后是一个摄像机咨询。决定做一个电话-只对相机咨询是在供应商的自由裁量权。结果。有1，029次电传，其中807次是在相机上（74%）。在8名远程中风提供者中，4名经验较少，刚刚完成中风奖学金，4名经验丰富（研究开始时平均有7.8年的远程中风经验）。经验较少的提供者比经验丰富的提供者更有可能在摄像机上进行（79% vs. 67%的咨询，p= 0.021），但在摄像机上进行tPA的可能性较小（25% vs. 33%，p = 0.023）。tPA给药的绝对比率、结合电话和相机给药的绝对比率或技术困难的频率没有差异。经验较少的Telestroke顾问不会通过电话对许多病例进行分类，并且不太可能在摄像机上管理tPA，这表明他们对远程医疗的使用没有优化。这支持在血管神经病学培训中引入遥程教学法。
Background. Stroke telemedicine (telestroke) increases tPA availability and administration. However, the effective use of telestroke requires training, which is not a standard component of vascular neurology training. As a result, many providers learn telestroke skills “on the job” after finishing their training.Aims. We sought to explore if providers with more telestroke experience would be more efficient in the utilization of telemedicine, compared to providers with less experience.Methods. We prospectively collected data on telestrokes between July 2014 and July 2017 at a Comprehensive Stroke Center. Telestrokes are initiated on the telephone and typically, but not always, followed by an on‐camera consult. Decision to do a phone‐only versus on‐camera consult is at the provider’s discretion.Results. There were 1,029 telestrokes, of which 807 were on‐camera (74%). Of the 8 telestroke providers, 4 had less experience, having just finished stroke fellowship, and 4 had more experience (mean = 7.8 years of telestroke experience at the beginning of the study). Providers with less experience were more likely to go on camera than providers with more experience (79% vs. 67% of consults,p= 0.021), but were less likely to give tPA when on‐camera (25% vs. 33%,p= 0.023). The absolute rate of tPA administration, combining phone and camera administration, or the frequency of technical difficulties were not different.Conclusions. Telestroke consultants with less experience do not triage as many cases by phone and are less likely to administer tPA on‐camera, suggesting their use of telemedicine is not optimized. This supports the introduction of telestroke didactics during vascular neurology training.