(VISIION-S): Viz.ai Implementation of Stroke augmented Intelligence and communications platform to improve Indicators and Outcomes for a comprehensive stroke center and Network - Sustainability

Kim Van Orden; Dawn Matherne Meyer; Emily S Perrinez; Dolores Torres; Briana Poynor; Ben Alwood; Julie Bykowski; Alex Khalessi; Brett C Meyer

doi:10.1016/j.jstrokecerebrovasdis.2023.107303

(VISIION-S): Viz.ai Implementation of Stroke augmented Intelligence and communications platform to improve Indicators and Outcomes for a comprehensive stroke center and Network - Sustainability

J Stroke Cerebrovasc Dis. 2023 Oct;32(10):107303. doi: 10.1016/j.jstrokecerebrovasdis.2023.107303. Epub 2023 Aug 10.

Authors

Kim Van Orden¹, Dawn Matherne Meyer², Emily S Perrinez³, Dolores Torres⁴, Briana Poynor⁵, Ben Alwood⁶, Julie Bykowski⁷, Alex Khalessi⁸, Brett C Meyer⁹

Affiliations

¹ Department of Neurosciences, University of California, San Diego, California, USA. Electronic address: kvanordenmd@gmail.com.
² Department of Neurosciences, University of California, San Diego, California, USA. Electronic address: dmmeyer@health.ucsd.edu.
³ Department of Neurosciences, University of California, San Diego, California, USA. Electronic address: esperrinez@health.ucsd.edu.
⁴ Department of Neurosciences, University of California, San Diego, California, USA. Electronic address: dolores.torres2018@gmail.com.
⁵ Department of Neurosciences, University of California, San Diego, California, USA. Electronic address: briana.moore.md@gmail.com.
⁶ Department of Neurosciences, University of California, San Diego, California, USA. Electronic address: benalwood@gmail.com.
⁷ Department of Neurosciences, University of California, San Diego, California, USA. Electronic address: jbykowski@health.ucsd.edu.
⁸ Department of Neurosciences, University of California, San Diego, California, USA. Electronic address: akhalessi@health.ucsd.edu.
⁹ Department of Neurosciences, University of California, San Diego, California, USA. Electronic address: bcmeyer@health.ucsd.edu.

PMID: 37572556
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107303

Abstract

Objectives: As Comprehensive Stroke Centers (CSCs) strive to improve neuro-intervention (NIR) times, process improvements are put in place to streamline workflows. Our prior publication (VISIION) demonstrated improvements in key performance indicators (KPIs). The purpose VISIION-S was to analyze whether those results were sustainable.

Materials and methods: Consecutive Direct Arriving LVO (DALVO) and telemedicine transfer LVO (BEMI) stroke NIR cases were assessed, including subgroups of DALVO-OnHours, DALVO-OffHours, BEMI-OnHours, and BEMI-OffHours. We analyzed times for the original 6 months pre (6/10/20-1/15/21) and compared them to a 17 month post-implementation period (1/16/21- 6/25/22) to evaluate for sustainability. Mann-Whitney U was utilized.

Results: 150 NIR cases were analyzed pre (n = 47) v. post (n = 103) implementation (DALVO-OnHours 7 v. 20, DALVO-OffHours 10 v. 25, BEMI-OnHours 13 v. 20, BEMI-OffHours 17 v. 38). For Door-to-groin (DTG), improvement was noted for DALVO-OffHours 39%(157 min,96 min;p < 0.001), DALVO-ALL 25%(127 min,95 min;p = 0.006), BEMI-OffHours 46%(45 min,25 min;p = 0.023), and BEMI-ALL 40%(42 min,25 min;p = 0.005). Activation-to-groin (ATG), door-to-device (DTD), and door-to-recanalization (DTR) also showed statistical improvements. For DALVO-OffHours, there were reductions in door to CT (DTC) 80%(26 min,5 min;p < 0.001), ATG 32%(90 min,61 min;p = 0.036), DTG 39%(157 min,96 min;p < 0.001), DTD 31%(178 min,123 min;p = 0.002), and DTR 32%(197 min,135 min;p = 0.003).

Conclusions: We noted sustainability over a 17 month period with sustained reduction in KPIs for even more NIR time interval comparisons. In the greatest opportunity subgroup (DALVO-OffHours), we noted a reduction in all 5 time interval metrics. Our sustainability finding is important to show that process improvements continued even after the immediate period, adding credibility to the results. Models such as this could be useful for other centers striving to optimize workflow and improve times.

Keywords: CSC; CT; Mismatch; NeuroIntervention; Perfusion; Sustainability.

MeSH terms

Humans
Stroke* / diagnosis
Stroke* / therapy
Time Factors
Time-to-Treatment