2011-10-21 ASIP Santé Conférence Télémédecine "Présentation TEMPiS"
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Transcript of 2011-10-21 ASIP Santé Conférence Télémédecine "Présentation TEMPiS"
Conférence Télémédicine et Télésanté en Europe
FIEEC / ASIP Santé
Paris, 21.10.2011
Dr. Peter Müller-BarnaDepartment of Neurology
Klinikum Harlaching
Städtisches Klinikum München GmbH
Telemedical Project for Integrative Stroke Care in Bavaria, Germany
Overview
• the need for stroke networks
• TEMPiS: key features
• TEMPiS: quality data
• TEMPiS: outcome analysis
• Summary
Overview
• the need for stroke networks
• TEMPiS: key features
• TEMPiS: quality data
• TEMPiS: outcome analysis
• Summary
Burden of Stroke
Strokes in Germany:
• 260.000 strokes every year
• #3 for death: 40% of the stroke patients die within 1 year
• #1 for disability: 1 million patients with long-term disability caused by stroke
Kolominsky-Rabas, Stroke 1998
→ Stroke is a public health challenge of prime importance
Changes in Age Distribution
2000 2050
→ Stroke is a public health challenge of prime importance
with increasing relevance !!!
What to do?
Stroke unit care• reduces death or dependency
(OR 0.82; 95% CI 0.73 to 0.92; P = 0.001)
NNT = 5
i.v.-Thrombolysisincreases favourable outcome• OTT 0-90 min NNT 4,5
(OR 2,55; 95% CI 1,44 to 4,52; P = 0.001)
• OTT 90-180 min NNT 9(OR 1,64; 95% CI 1,12 to 2,40; P = 0.012)
• OTT 180-270min NNT 14(OR 1,34; 95% CI 1,06 to 1,68; P = 0.014)
Lees et al., Lancet 2010Cochrane Database of Systematic Reviews 2009
Time is BrainIn acute stroke 1.9 million neurons die every minute!
Only a minority of all stroke patients in Europe receive stroke unit care Leys, Stroke 2007
Stroke Units in Bavaria, Germany, in 2002
4Stroke Unit
Stroke Center
Network-Hospital
The need in 2002 was
to improve stroke care
in the underserved
areas of Bavaria.
Overview
• the need for stroke networks
• TEMPiS: key features
• TEMPiS: quality data
• TEMPiS: outcome analysis
• Summary
Exchange of Experience Teleconsultations
Training –
center-based and onsite
Standardtreatment protocols
Key features of the TEMPiS-Network
Implementation of Stroke
wards in each hospital
Quality Management
1. Stroke Wards
Implementation of Stroke Wards
in each network hospital:
• stroke wards with
3-6 monitored beds and
~ 15 additional beds
• well defined stroke team consisting of:
doctors, nurses, physiotherapists, ergotherapists,
speech & swallowing therapists and social workers
• (on site) ward round of a neurologist from Monday
to Friday
• continuous medical training
• concept of early rehabilitation
2. Standard treatment protocols - SOPs
Our TEMPiS-SOPs form our common basis of
managing stroke:
• TEMPiS-SOPs were developed and are updated
yearly in a cooperative effort
• with statements for doctors,
nurses and therapists
• we obligate and control network
hospitals to follow the SOPs
Stroke classes Training days for
speech & swallowing therapists
3. Centre based Training
LaryngoscopyStroke Update Sonography
3. Onsite training
Regular ward rounds
in each network hospital
Bedside training for nurses
Bedside training for therapists
4. Exchange of Experience
www.tempis.de
Newsletter
Ward rounds & Meetings
5. Quality Management
Visitation of all network hospitals by the project manager at least 3 times per year
Evaluation of teleconsultations
benchmarking of the rate of thrombolysis, the door-to-needle-time, etc.
obligatory participation in the German stroke register database
documentation and analysis of critical incidences
DSL
Academic Stroke Center
6. Teleconsultation - Network Hospital
6. Stationary workstation – Stroke Center
6. Teleconsultation – mobile solution
works with fast UMTS = HSDPA (High Speed Downlink Packet Access)
6. Teleconsultations
Obligatory indication for a teleconsultation:
• onset of symptoms within 4.5 hours
• intracranial hemorrhage
• impaired consciousness
• progressive stroke
• brainstem symptoms
• NIH-SS 12
• stroke patients aged < 60 years
A voluntary teleconsultation is possible whenever requested !
Exchange of Experience Teleconsultations
Training –
center-based and onsite
Standardizedtreatment protocols
Main capabilities of the TEMPiS-Network
Implementation of Stroke
wards in each hospital
Quality Management
TEMPiS is based on personal relationship,
know-how transfer, quality management
and telemedicine
► TEMPiS is a regional network with limited size
Overview
• the need for stroke networks
• TEMPiS: key features
• TEMPiS: quality data
• TEMPiS: outcome analysis
• Summary
number of teleconsultations per year
Source : TEMPiS-database of teleconsultations
1.924
2.688
2.859 2.837
3.062
3.560
3.1873.216
0
1.000
2.000
3.000
2003 2004 2005 2006 2007 2008 2009 2010
admission to CT-scan: less than 60 minutes
Source: BAQ
67%
76%
81%
85% 85%
87% 88% 88% 88%
91% 91%92%
93%94%
96%
87%
80%
60%
70%
80%
90%
100%E
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2009 2010
TEMPiS
Teleconsultations
since 2003 more than 25.000 teleconsultations
currently ~ 360 per month
Thrombolysis with rt-PA
since 2003 about 2.300 thrombolysis
currently ~ 45 per month
~ 6.500 strokes per year in the 15 regional
network hospitals (extra 1.800 strokes in the stroke
centres Harlaching and Regensburg)
tele-stroke units vs. conventional stroke units
0% 20% 40% 60% 80% 100%
Information Patient und Angehörige
Physiotherpie / Ergotherapie
Mobilisierung
Screening nach Schluckstörung
Logopädie
Bildgebung
Gefäßdiagnostik
TAH innerhalb 48h
TAH bei Entlassung
Antikoagulation bei VHFli
Frühzeitige Thrombolyse
Door to needle time
Pneumonierate
Todesfälle TEMPiS-Kooperationskliniken (15)BAQ gesamt (80 Kliniken)
Source: BAQ; analysis for 2010
mortality
rate of pneumonia
door to needle time
early thrombolysis
anticoagulation in AF
antiplatelet drugs at discharge
antiplatelet drugs at 48h
carotid duplex or CTA
CT scan
early speech therapy
screening for dysphagia
early mobilisation
early physiotherapy
information for patient/relatives
Overview
• the need for stroke networks
• TEMPiS: key features
• TEMPiS: quality data
• TEMPiS: outcome analysis
• Summary
TEMPiS outcome trial
• Prospectively obtained data of 3122 stroke patients
• ComparingOutcome of patients treated in network hospitals to
Outcome of patients treated in control hospitals
• poor Outcomedead or
institutional care or
at home with severe disability
Lancet Neurol 2006; 5: 742–48
Poor Outcome after 3 Months
TEMPiS Control hospitals
18,1%16,2% Dead
InstitutionalCare
12,5% 14,2%
At home withsevere disability14,3% 21%
-10,4%**
Lancet Neurol 2006; 5: 742–48
43,0% 53,4%
overview
• the need for stroke networks
• TEMPiS: key features
• TEMPiS: quality data
• TEMPiS: outcome analysis
• Summary
Take home ...
Telestroke is part of routine stroke care in Bavaria.
TEMPiS is a regional network based on personal relationship,
know-how transfer, quality management and telemedicine.
Stroke care within this kind of network improves the prognosis
of stroke patients.
Acknowledgement
We thank
► all participating stroke neurologists in the stroke centres
► all TEMPiS hospitals:
Asklepios Stadtklinik Bad TölzKreisklinik Bad Reichenhall Asklepios Klinik BurglengenfeldKreisklinik ChamKlinikum DachauKreisklinik EbersbergKreisklinik EggenfeldenKlinikum Freising
Kreiskrankenhaus Kelheim Kreisklinik MühldorfKlinik München-PasingKlinikum RosenheimKlinikum St. Elisabeth StraubingKlinikum TraunsteinKrankenhaus Zwiesel
Dr. Peter Müller-Barna
Consultant - Coordinator of TEMPiS
Department of Neurology and
Neurologic Intensive Care
Städtisches Klinikum München GmbH
Klinikum Harlaching Sanatoriumsplatz 2 - 81545 München
Tel. 089 6210 2259E-Mail: [email protected]
www.tempis.de
Thank you for your attention!