Poster Abstracts
Meet the authors at the poster presentation session , Wednesday from 12:50 to 1:20 pm in the Expo Hall . Abstract number indicates poster location in Expo Hall .
1 . Using Synchronous , TeleWound Visits to Teach and Confirm Competencies in Nursing Wound Care
Patricia Arocho , RN , BSN , Scott Bolhack , MD , MBA , Robin McCollester , MEd , NSN , RN-BC , Cynthia Bakko , RN , BSN , Florence Gores , RN , MPS
Southern Arizona VA Health Care System
Background : The Southern Arizona Veterans Administration Health Care System ( SAVAHCS ) was awarded a grant to develop a TeleWound program for the veterans in VISN 18 . Veterans are examined while at their Community Based Outpatient Center ( CBOC ) by a Wound Certified Physician and Wound Trained Registered Nurse from the base office in Tucson ; each CBOC has a dedicated , trained telehealth nurse who presents the patient , characterizes the wound ( measurements , odor , pain , drainage , etc .), and performs other aspects of the wound care .
Method : The telehealth nurses in the CBOCs are not dedicated wound care nurses ; they have responsibility for multiple telehealth programs within the SAVAHCS system . The general wound care knowledge of the telehealth nurse reflects variability that is common in this medical specialty . Our dedicated Telemedicine Wound Care Nurse Specialist developed a Wound Care Competency List to use as a guide and basis of the essential skills needed to care for the veterans with chronic wounds in our program . In lieu of a dedicated wound care education program , it was decided that at the time of our patient visits , the Telemedicine Wound Physician and the Telemedicine Wound Care Nurse Specialist would use the opportunity to educate , teach , acknowledge , and record expertise in the competencies .
Results : Since some of the competencies require recognizing certain conditions and disease states , the completion of the competencies will require exposure to many patients over time . The nursing staff has responded positively to the teaching moments and we educate with actual patients in a manner that is not burdensome to the patient or that delays the encounter unnecessarily . This has increased the efficiency of the program greatly in the early course .
Conclusions : Telemedicine programs can effectively be used to educate professional staff . By incorporating the education component along with the patient visit , the Telehealth nurses can be trained without traveling to the main Tucson Medical Facility .
2 . Positive Impact Through Use of Telestroke in Two Large Pacific Northwest Networks on Clinical Performance
Elizabeth Baraban , PhD , Lindsay Lucas , MS , Alexandra Lesko
Providence Brain and Spine Institute , Providence Health and Services
Background : Stroke treatment is available for eligible stroke patients but must be administered within 4.5 hours of onset . Unfortunately , rural communities rarely have access to specialized care to treat stroke in a timely manner in order to prevent poor outcomes . Telestroke programs have been gaining wider acceptance to address this gap in specialty care . This study looks at the efficacy of telestroke in the Pacific Northwest for two large telestroke networks .
Methods : Data include patients presenting at 26 hospitals within 4.5 hours of stroke onset from 2013-2015 . Efficacy of telestroke was measured by clinical performance measures which include use of a clot-busting drug ( IV tPA ), time from patient arrival to receiving a computed tomography ( CT ) scan , and patient arrival to administration of IV tPA . Medians and interquartile ranges are reported .
Results : The number of patients included in the analyses were 1801 from 2013-2015 . The percent of patients treated with IV tPA increased from 15 % ( n = 97 ) to 20 % ( n = 121 ) from 2013 to 2015 . The median door to CT time decreased from 33.0 [ 16.0 , 59.8 ] minutes to 26.0 [ 11.0 , 53.3 ] minutes and the overall median door to treatment times decreased from 73.0 [ 59.0 , 94.0 ] minutes to 66.0 [ 49.0 , 96.0 ] minutes . For those cases that utilized the robot versus no use of robot , the treatment times were lower in 2013 ( 70.0 minutes [ 59.0 , 91.5 ] versus 78.5 minutes [ 62.0 , 112.3 ]. Likewise , cases using the robot were lower in 2015 ( 62.5 minutes [ 48.0 , 88.3 ]) versus those that did not ( 74.5 minutes [ 54.0 , 105.3 ]).
Conclusions : Our data show that telestroke has been beneficial over time . Time to treat decreased over time , was lower when telestroke was used and the overall percentage of patients being treated increased with time . Telestroke is an important clinical tool that can be used to improve stroke care in communities with fewer healthcare resources .
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