Patient's understanding of and satisfaction with acute stroke treatment.

OBJECTIVE: We aimed to assess patient and surrogate understanding of and satisfaction with communication regarding acute stroke treatments of intravenous thrombolysis (IVT) and endovascular therapy (EVT). METHODS: In this single health-system prospective observational study, patients or their surrogates were interviewed within 72 h of acute stroke therapy. Respondent's satisfaction and self-reported understanding were rated on a Likert scale. Responses to open-ended questions were evaluated for recall of purpose and risks of treatment. RESULTS: Of 56 completed interviews (24 patients and 32 surrogates), 33 patients received IVT alone, 11 IVT and EVT, 12 EVT alone. Forty participants (71%) reported being extremely satisfied with their acute stroke care, 46 (82%) reported no difficulty understanding the purpose of treatment, while 36 (64%) reported no difficulty understanding risks. Two or more risks were verbalized by 8 (24%) participants for IVT, 2 (17%) for EVT, and 7 (64%) for both IVT and EVT. Brain bleeding was the most recalled risk for IVT and "lack of benefit" for EVT. CONCLUSIONS: Majority of the participants were extremely satisfied and reported no difficulty understanding purpose and risks of acute stroke treatment, however only 30% were able to verbalize two or more risks associated with the treatment.

The early impact of COVID-19 pandemic on mobile stroke unit care delivery: A worldwide survey.

OBJECTIVE: To report COVID -19 pandemic impact on mobile stroke units (MSUs) a world-wide survey of MSU programs. METHODS: Contact information of MSU program was obtained through the Pre-hospital Stroke Treatment Organization. Anonymous electronic questionnaire was developed and sent through the email to one representative of each program on May 15, 2020. RESULTS: Of 26 programs queried, 20 responded and completed survey based on the data or personal impression. Eighteen programs were in the regions with pandemic lockdown. Six either suspended or reduced MSU availability at some point. The reasons given for change in availability were as follows: decreased personnel availability (5 programs), risk of exposure (5 programs), and financial concerns (1 program). Staff availability was a concern among 8 programs. MSU activations were reported to be unchanged by 10 programs, but 9 programs experienced decline in activation, 1 program had more activations. Sixteen programs reported change in MSU protocol including introduction of screening questionnaire, PPE, reducing patient contact, and cleaning protocols. Nine reported that the crew was under greater stress. Only 2 respondents felt that the pandemic delayed stroke care on MSU and the remainder did not. CONCLUSION: Overall Stroke care delivery had no major disruptions despite COVID 19 pandemic posed challenges to MSU Operations.

Virtual Rounding in Stroke Care and Neurology Education During the COVID-19 Pandemic - A Residency Program Survey.

BACKGROUND AND PURPOSE: During the coronavirus disease 2019 (COVID-19) pandemic, we instituted virtual inpatient stroke rounds and acute stroke evaluations via telemedicine in the emergency department. We sought to explore trainees' and experienced providers' views on stroke care and education. METHODS: The implementation and the survey took place at a single academic comprehensive stroke center in northeast Ohio in the United States. "Virtual rounding" consisted of patient presentation and discussion in the morning in on-line virtual team format followed by in-person patient rounds in small groups. Acute stroke evaluations in the emergency department included direct in-person evaluation by neurology residents with supervision over telemedicine.The neurology residents, stroke fellows, stroke nurse practitioners, and stroke staff physicians were surveyed 2 months after implementation. Quantitative data was analyzed using descriptive statistical analysis, written responses in comment sections were analyzed using content analysis. RESULTS: Thirty-two of 42 (73%) surveys were completed. Nine (45%) residents and 5 (42%) experienced providers responded that virtual rounds did not compromise learning and education on stroke service. Fifteen (75%) residents and all experienced providers agreed that virtual rounds protected caregivers from exposure to the virus. While more than a third of residents (37%) did not feel comfortable utilizing telemedicine in ED, the majority of experienced providers (89%) were at ease with it. A total of 58% of residents and 67% of experienced providers felt that they were spending less time at the bedside, and 42% of residents and 58% of experienced providers felt less connected to patients during the pandemic. CONCLUSION: Majority of neurology residents' experience was not positive utilising telemedicine as compared to other staff providers. This is likely attributed to lack of prior exposure and unpreparedness. Incorporation of telemedicine curricula in medical school and residency training could prepare the next generation physicians to effectively use these technologies and meet the growing need for telehealth services for current and future pandemics.

Risk Factors for Unplanned Readmissions Following Anterior Cervical Discectomy and Fusion and Posterior Lumbar Fusion Procedures: Comparison of Two National Databases.

BACKGROUND: The National Surgical Quality Improvement Program (NSQIP) and National Readmission Database (NRD) are 2 widely used databases that provide valuable information regarding the quality of health care. However, the 2 differ in sampling methodology, which may result in conflicting findings when used for research studies. The objective of this study is to evaluate the differences regarding predictors of 30-day readmissions after anterior cervical discectomy and fusion (ACDF) and posterior lumbar fusion (PLF). METHODS: In this case-control study, NSQIP and NRD were queried for patients undergoing elective ACDF and PLF between 2014 and 2015. The outcome of interest was 30-day readmissions following ACDF and PLF, which were unplanned and related to the index procedure. Subsequently, univariable and multivariable analyses were conducted to determine the predictors of 30-day readmissions using both databases. RESULTS: For ACDF procedures, diagnosis, outpatient status, American Society of Anesthesiologists class, and length of hospital stay were found to be significant predictors of 30-day readmissions in NSQIP, whereas only age and hypertension were significant in NRD. Among patients undergoing PLF procedures, body mass index, functional status, smoking, steroid use, diabetes, dyspnea, dialysis, emergency, discharge to rehab facility, and length of hospital stay were found to be significant predictors of 30-day readmissions in NSQIP, whereas only alcohol abuse and obesity were significant predictors in NRD. CONCLUSIONS: Two databases differed in terms of significant predictors of 30-day readmissions following ACDF and PLF. This difference may emphasize the differences in the sampling methodology. Further analyses, potentially with an institutional validation, are needed to draw conclusions regarding the accuracy of the 2 databases for predictive analytics.

Outpatient Versus Inpatient Posterior Lumbar Fusion for Low-Risk Patients: An Analysis of Thirty-Day Outcomes From the National Surgical Quality Improvement Program.

BACKGROUND: Outpatient spine surgery has been increasingly used recently owing to its perceived cost benefits and its ability to offset the volume from the inpatient setting. However, the 30-day outcomes of outpatient posterior lumbar fusion (PLF) for low-risk patients have not been extensively studied. In the present study, we assessed the 30-day outcomes of outpatient PLF surgery for low-risk patients using a national surgical quality registry. METHODS: For the present study, we queried the American College of Surgeons National Surgical Quality Improvement Program for patients who had undergone PLF from 2009 to 2016. Only patients with an American Society of Anesthesiologists grade of 1-2 were included. The 30-day outcomes, including any complications, readmissions, and reoperations, were studied using multivariable logistic regression after adjustment for an array of patient-specific factors. RESULTS: A total of 29,830 cases were identified. Of these 29,830 cases, 1016 (3.4%) had been performed as outpatient cases and 28,814 (96.6%) as inpatient. After adjusting for an array of patient-specific factors, we did not find any significant association between the procedure setting and complication rate (odds ratio [OR], 0.8; 95% confidence interval [CI], 0.6-1.1; P = 0.15) or 30-day readmission rate (OR, 0.9; 95% CI, 0.6-1.4; P = 0.76). Patients undergoing outpatient PLF were more likely to have required a 30-day reoperation (OR, 1.6; 95% CI, 1.1-2.4; P = 0.02). CONCLUSION: Our results have demonstrated that the 30-day outcomes of patients who have undergone outpatient PLF might be comparable to those of patients who have undergone PLF in an inpatient setting. However, outpatient surgery might be associated with a greater overall reoperation rate.