2021
Rising to the challenges of the pandemic: Telehealth innovations in U.S. emergency departments
Uscher-Pines L, Sousa J, Mehrotra A, Schwamm L, Zachrison K. Rising to the challenges of the pandemic: Telehealth innovations in U.S. emergency departments. Journal Of The American Medical Informatics Association 2021, 28: 1910-1918. PMID: 34022045, PMCID: PMC8194856, DOI: 10.1093/jamia/ocab092.Peer-Reviewed Original ResearchMeSH KeywordsAftercareCOVID-19Emergency Service, HospitalHumansPandemicsPatient DischargeSARS-CoV-2TelemedicineUnited StatesConceptsEmergency departmentTelehealth programED leadersU.S. emergency departmentsCoronavirus disease 2019 (COVID-19) pandemicDisease 2019 pandemicPersonal protective equipmentTelehealth applicationsPostdischarge assessmentsAcute careVirus exposureVisit volumeOngoing COVID-19Telehealth implementationTele-triageMaximum variation samplingProtective equipmentTelehealth innovationCOVID-19Tele-consultationCOVID-19 pandemicImplementation supportCarePandemicLiterature review
2020
Language preference does not influence stroke patients' symptom recognition or emergency care time metrics
Zachrison K, Natsui S, Luan Erfe B, Mejia N, Schwamm L. Language preference does not influence stroke patients' symptom recognition or emergency care time metrics. The American Journal Of Emergency Medicine 2020, 40: 177-180. PMID: 33168382, DOI: 10.1016/j.ajem.2020.10.064.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overEmergency Service, HospitalEmergency TreatmentFemaleHumansLanguageMaleMiddle AgedRegistriesStrokeTime-to-TreatmentConceptsResearch Patient Data RegistrySymptom recognitionDTN timeHospital arrivalSymptom discoveryAIS patientsEMS utilizationGuidelines-Stroke registryPatients' language preferenceConsecutive AIS patientsPatient Data RegistryUse of EMSEmergency medical servicesLanguage preferenceAcute strokeNeedle timeSymptom onsetEP patientsData registryAcademic centersPatientsPrior reportsMedical servicesSignificant differencesRegistryWhat Drives Greater Assimilation of Telestroke in Emergency Departments?
Uscher-Pines L, Sousa J, Zachrison K, Guzik A, Schwamm L, Mehrotra A. What Drives Greater Assimilation of Telestroke in Emergency Departments? Journal Of Stroke And Cerebrovascular Diseases 2020, 29: 105310. PMID: 32992169, PMCID: PMC7686253, DOI: 10.1016/j.jstrokecerebrovasdis.2020.105310.Peer-Reviewed Original ResearchAttitude of Health PersonnelClinical ProtocolsDelivery of Health Care, IntegratedEmergency Service, HospitalHealth Knowledge, Attitudes, PracticeHumansInterviews as TopicLeadershipPractice Patterns, Physicians'Quality ImprovementQuality Indicators, Health CareReferral and ConsultationStrokeTelemedicineWorkflowImpact of Emergency Department Crowding on Delays in Acute Stroke Care
Jaffe T, Goldstein J, Yun B, Etherton M, Leslie-Mazwi T, Schwamm L, Zachrison K. Impact of Emergency Department Crowding on Delays in Acute Stroke Care. Western Journal Of Emergency Medicine 2020, 21: 892-899. PMID: 32726261, PMCID: PMC7390586, DOI: 10.5811/westjem.2020.5.45873.Peer-Reviewed Original ResearchMeSH KeywordsAgedBrain IschemiaCrowdingDelayed DiagnosisEmergency Service, HospitalEmergency TreatmentFemaleHumansMaleMassachusettsQuality of Health CareRetrospective StudiesStrokeTime-to-TreatmentConceptsAcute stroke careStroke careED crowdingEndovascular therapyConsecutive acute ischemic stroke patientsCare deliveryAcute ischemic stroke patientsGroin puncture timeGuidelines-Stroke registryStroke care deliveryHealth Stroke ScaleIschemic stroke patientsMultiple clinical factorsUrban academic EDInitial stroke severityHigh ED utilizationSingle-institution analysisAcute care deliveryEmergency stroke careOutcomes of interestWilcoxon rank sum testEmergency department (ED) crowdingRank sum testAlteplase deliveryDTN time
2018
Comparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States
Man S, Zhao X, Uchino K, Hussain M, Smith E, Bhatt D, Xian Y, Schwamm L, Shah S, Khan Y, Fonarow G. Comparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States. Circulation Cardiovascular Quality And Outcomes 2018, 11: e004512. PMID: 29794035, PMCID: PMC5978771, DOI: 10.1161/circoutcomes.117.004512.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCertificationComprehensive Health CareDelivery of Health Care, IntegratedEmergency Service, HospitalEndovascular ProceduresFemaleHospital MortalityHospitalsHumansMaleMiddle AgedOutcome and Process Assessment, Health CarePatient AdmissionPatient TransferQuality ImprovementQuality Indicators, Health CareRecovery of FunctionRegistriesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsPrimary stroke centerEmergency department admissionsStroke center certificationAcute ischemic strokeIschemic stroke careStroke centersStroke careDepartment admissionsHospital mortalityHospital outcomesIntravenous tPAIschemic strokeCenter certificationTPA timeComprehensive Stroke Center (CSC) certificationAcute ischemic stroke careMultivariable logistic regression modelAcute reperfusion therapyAcute stroke triageBrain Attack CoalitionDefect-free careComprehensive stroke centerOverall care qualityLogistic regression modelsGuidelines-StrokeImplementation of a Rapid, Protocol-based TIA Management Pathway
Jarhult S, Howell M, Barnaure-Nachbar I, Chang Y, White B, Amatangelo M, Brown D, Singhal A, Schwamm L, Silverman S, Goldstein J. Implementation of a Rapid, Protocol-based TIA Management Pathway. Western Journal Of Emergency Medicine 2018, 19: 216-223. PMID: 29560046, PMCID: PMC5851491, DOI: 10.5811/westjem.2017.9.35341.Peer-Reviewed Original ResearchMeSH KeywordsAgedClinical ProtocolsEmergency Service, HospitalFemaleHumansIschemic Attack, TransientLength of StayMaleNeuroimagingConceptsTransient ischemic attackTotal hospital LOSHospital LOSEmergency departmentED LOSFinal diagnosisRecurrent transient ischemic attacksTertiary care academic centerED observation unitIntermediate-risk patientsHigh-risk patientsProportion of patientsMedian ED LOSInpatient admission ratesNeck CT angiographyBrain magnetic resonanceNeck MR angiographyStandardized clinical protocolUse of neuroimagingIschemic attackCohort studyTIA symptomsConsecutive patientsED lengthSix-month period
2017
Characterizing New England Emergency Departments by Telemedicine Use
Zachrison K, Hayden E, Schwamm L, Espinola J, Sullivan A, Boggs K, Raja A, Camargo C. Characterizing New England Emergency Departments by Telemedicine Use. Western Journal Of Emergency Medicine 2017, 18: 1055-1060. PMID: 29085537, PMCID: PMC5654874, DOI: 10.5811/westjem.2017.8.34880.Peer-Reviewed Original ResearchConceptsNew England Emergency DepartmentsRural emergency departmentsEmergency departmentTelemedicine useED characteristicsLow-volume emergency departmentsMultivariable logistic regressionConsultant availabilityIndependent predictorsMultivariable analysisPatient careLogistic regressionPlastic surgeryClinical applicationDescriptive statisticsTelemedicineEngland surveyPrimary objectiveAnnual volumeDepartmentNew England statesPsychiatrySurgeryPediatricsStroke
2013
Patterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment
Ekundayo O, Saver J, Fonarow G, Schwamm L, Xian Y, Zhao X, Hernandez A, Peterson E, Cheng E. Patterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment. Circulation Cardiovascular Quality And Outcomes 2013, 6: 262-269. PMID: 23633218, DOI: 10.1161/circoutcomes.113.000089.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overChi-Square DistributionEmergency Medical ServicesEmergency Service, HospitalEthnicityFemaleGuideline AdherenceHealth Knowledge, Attitudes, PracticeHumansMaleMiddle AgedMinority GroupsOdds RatioOutcome and Process Assessment, Health CarePatient Acceptance of Health CarePatient Education as TopicPractice Guidelines as TopicRegistriesRisk FactorsStrokeTime FactorsTime-to-TreatmentTransportation of PatientsTreatment OutcomeUnited StatesConceptsEmergency medical servicesStroke patientsEMS useEmergency medical services useMinority raceHealth Stroke ScoreMedical service useTreatment of strokeTissue-type plasminogen activatorEligible patientsGuidelines-StrokeSevere strokeStroke ScoreHospital arrivalOlder patientsYounger patientsHemorrhagic strokeStroke treatmentMedicare insuranceInsurance statusEMS activationDecreased oddsEMS transportService usePatients
2012
Emergency Medical Service Hospital Prenotification Is Associated With Improved Evaluation and Treatment of Acute Ischemic Stroke
Lin C, Peterson E, Smith E, Saver J, Liang L, Xian Y, Olson D, Shah B, Hernandez A, Schwamm L, Fonarow G. Emergency Medical Service Hospital Prenotification Is Associated With Improved Evaluation and Treatment of Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2012, 5: 514-522. PMID: 22787065, DOI: 10.1161/circoutcomes.112.965210.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCommunicationEmergency Medical ServicesEmergency Service, HospitalFemaleFibrinolytic AgentsGuideline AdherenceHealth Services AccessibilityHospitalsHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisOutcome and Process Assessment, Health CarePractice Guidelines as TopicQuality ImprovementRegistriesStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic strokeTissue plasminogen activatorNeedle timeEMS prenotificationHospital prenotificationIschemic strokeEligible patientsShorter doorIntravenous tissue plasminogen activatorClustering of patientsShorter symptom onsetQuality of careGuidelines-StrokeTPA useSymptom onsetPotential strokeStroke treatmentPatientsPoisson regressionStrokeTreatment ratesIncoming patientsGreater likelihoodPrenotificationMinutesTimes From Symptom Onset to Hospital Arrival in the Get With The Guidelines–Stroke Program 2002 to 2009
Tong D, Reeves M, Hernandez A, Zhao X, Olson D, Fonarow G, Schwamm L, Smith E. Times From Symptom Onset to Hospital Arrival in the Get With The Guidelines–Stroke Program 2002 to 2009. Stroke 2012, 43: 1912-1917. PMID: 22539544, DOI: 10.1161/strokeaha.111.644963.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overDatabases, FactualEmergency Medical ServicesEmergency Service, HospitalHumansMiddle AgedPractice Guidelines as TopicStrokeTime FactorsConceptsAcute ischemic strokeIschemic strokeSymptom onsetDoor timeHospital arrivalIntravenous tissue-type plasminogen activatorAcute ischemic stroke therapyEmergency medical services transportFourth of patientsGuidelines-Stroke programProportion of patientsHospital arrival timeIschemic stroke therapyPlasminogen activator therapyPortion of patientsTissue-type plasminogen activatorEligible patientsStroke therapyActivator therapyAcute interventionNationwide studyTreatment windowPatientsEarly onsetStrokePredictors of Increased Intravenous Tissue Plasminogen Activator Use Among Hospitals Participating in the Massachusetts Primary Stroke Service Program
Rost N, Smith E, Pervez M, Mello P, Dreyer P, Schwamm L. Predictors of Increased Intravenous Tissue Plasminogen Activator Use Among Hospitals Participating in the Massachusetts Primary Stroke Service Program. Circulation Cardiovascular Quality And Outcomes 2012, 5: 314-320. PMID: 22534407, PMCID: PMC3361890, DOI: 10.1161/circoutcomes.111.962829.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overEmergency Service, HospitalFemaleFibrinolytic AgentsHealthcare DisparitiesHumansInfusions, IntravenousLinear ModelsLogistic ModelsMaleMassachusettsMiddle AgedMultivariate AnalysisOdds RatioPatient SelectionPractice Guidelines as TopicQuality ImprovementRegional Medical ProgramsRetrospective StudiesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeConceptsIntravenous tissue plasminogen activator useTissue plasminogen activator useAcute ischemic strokeTPA useIschemic strokeOlder acute ischemic stroke patientsAcute ischemic stroke patientsGuidelines-Stroke programStroke center designationIschemic stroke patientsRate of thrombolysisQuality improvement initiativesEmergency medical servicesStroke onsetSymptom onsetStroke patientsTreatment disparitiesCenter designationPatientsHospitalMassachusetts DepartmentImprovement initiativesMedical servicesOverall rateFurther studiesPredictors of Rapid Brain Imaging in Acute Stroke
Kelly A, Hellkamp A, Olson D, Smith E, Schwamm L. Predictors of Rapid Brain Imaging in Acute Stroke. Stroke 2012, 43: 1279-1284. PMID: 22442169, DOI: 10.1161/strokeaha.111.626374.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedDiabetes MellitusEmergency Service, HospitalFemaleFibrinolytic AgentsGuideline AdherenceHumansMagnetic Resonance ImagingMaleMultivariate AnalysisNeuroimagingPractice Guidelines as TopicRacial GroupsRetrospective StudiesSex FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTomography, X-Ray ComputedConceptsEmergency department arrivalBrain imagingSymptom onsetHealth Stroke Scale scoreFuture quality improvement initiativesGuidelines-Stroke programStroke Scale scoreStroke symptom onsetAcute stroke symptomsHistory of diabetesPeripheral vascular diseaseMultivariable logistic regressionQuality improvement initiativesEffectiveness of thrombolysisOverall imaging rateProsthetic heart valvesPredictive variablesAcute strokeMost patientsHospital clusteringIndependent predictorsStroke symptomsNonwhite raceEmergency departmentVascular disease
2008
Advance Hospital Notification by EMS in Acute Stroke Is Associated with Shorter Door-to-Computed Tomography Time andIncreased Likelihood of Administration of Tissue-Plasminogen Activator
Abdullah A, Smith E, Biddinger P, Kalenderian D, Schwamm L. Advance Hospital Notification by EMS in Acute Stroke Is Associated with Shorter Door-to-Computed Tomography Time andIncreased Likelihood of Administration of Tissue-Plasminogen Activator. Prehospital Emergency Care 2008, 12: 426-431. PMID: 18924004, DOI: 10.1080/10903120802290828.Peer-Reviewed Original ResearchConceptsEmergency medical servicesTissue plasminogen activatorAcute stroke patientsStroke patientsTertiary care stroke centerIntravenous tissue plasminogen activatorCatheter-based thrombolysisED arrival timeHospital time intervalsIntra-arterial thrombolysisMedian National InstitutesHealth Stroke ScaleUse of thrombolysisEmergency department arrivalTerms of ageHigher baseline ratesPrior strokeTPA useAcute strokeStroke centersStroke ScaleSymptom onsetStroke databaseMild strokeHospital notification
2004
Virtual TeleStroke Support for the Emergency Department Evaluation of Acute Stroke
Schwamm L, Rosenthal E, Hirshberg A, Schaefer P, Little E, Kvedar J, Petkovska I, Koroshetz W, Levine S. Virtual TeleStroke Support for the Emergency Department Evaluation of Acute Stroke. Academic Emergency Medicine 2004, 11: 1193-1197. PMID: 15528584, DOI: 10.1197/j.aem.2004.08.014.Peer-Reviewed Original ResearchConceptsTissue plasminogen activatorAcute strokeTelestroke consultationNeedle timeSymptom onsetEmergency departmentHealth Stroke Scale scoreIntravenous tissue plasminogen activatorMean National InstitutesPossible acute strokeEmergency department evaluationStroke Scale scoreAcute ischemic strokeEvaluation of patientsEligible patientsStroke neurologistsIschemic strokeDepartment evaluationNeurologic examinationRandomized trialsStroke expertiseProtocol violationsEmergency physiciansInter-rater reliabilityPatient management