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European Journal of Physical and Rehabilitation Medicine 2019 April;55(2):141-7

DOI: 10.23736/S1973-9087.18.05361-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Efficiency in stroke management from acute care to rehabilitation: bedside versus telemedicine consultation

Franco MOLTENI 1, Marina GAFFURI 1, Mario GUIDOTTI 2, Nicoletta CHECCARELLI 2, Maria COLOMBO 1, Chiara LORENZON 1, Chiara GIOVANZANA 1, Alessandro SPECCHIA 1, Giovanni CANNAVIELLO 1

1 Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy; 2 Department of Neurology, Valduce Hospital, Como, Italy



BACKGROUND: Telemedicine has changed over the last years, becoming an integrated service used in various clinical settings such as stroke units or radiological departments, but also as an important tool for home rehabilitation. Assessment of usefulness and efficiency of performing teleconsultations to manage stroke from acute care hospital to tertiary care rehabilitation hospital has not been referred by scientific literature.
AIM: This article analyzes the process of discharging stroke patients from acute care to intensive rehabilitation, based on the comparison between conventional bedside patient evaluations and teleconsultation patient evaluations, to assess efficiency and efficacy of two different discharging workflows.
DESIGN: Retrospective study.
SETTING: Consultations were carried out between the Acute Care Stroke Unit and the Stroke Rehabilitation Unit of Valduce Hospital System.
POPULATION: The study included 257 stroke patients who underwent physiatric consultation during 2 years considered in this study and 101 patients were considered eligible for intensive rehabilitation treatment after a physiatric consultation.
METHODS: We compared the efficiency and efficacy of the dismission workflow of bedside medical consultation and teleconsultation over a 12 months period. We considered the following outcome measures: time elapsed between consultation and Rehabilitation Unit admission, number of re-admissions to acute care hospital, complications occurred during rehabilitation, length of stay in the rehabilitation hospital and clinical outcomes of rehabilitation process.
RESULTS: We observed a significant reduction in waiting time from the acute event to the admission in rehabilitation department, an improvement in efficiency of the admission process itself in the Rehabilitation Unit and a reduction of clinical complications occurred during rehabilitation period, without changes in rehabilitative outcomes.
CONCLUSIONS: It has been highlighted that the use of telemedicine to perform medical consultation as a tool to evaluate patients eligible for tertiary care rehabilitation hospital admission from Stroke Care Unit is feasible and more efficient when compared with conventional bedside consultations.
CLINICAL REHABILITATION IMPACT: This study reveals teleconsultations as a useful tool to improve efficiency of the stroke management workflow.


KEY WORDS: Telemedicine; Remote consultation; Stroke rehabilitation

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