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Appropriateness, safety, and effectiveness of “drip and ship” teleconsultation model in Southeastern Tuscany: a feasibility study

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Abstract

Purpose

Teleconsultation is a consultation between two or more physicians about the diagnostic work-up and therapeutic strategy in the treatment of an individual case by means of modern telematics. ‘Drip-and-ship’ teleconsultation model consists of the transfer of patients, through telematics stroke networks, with large arteries occlusions from primary to comprehensive stroke centers equipped for endovascular therapy. We retrospectively investigated appropriateness, safety, and effectiveness of ‘drip-and-ship’ teleconsultation model in a rural area of Tuscany.

Methods

Outcome measures were: door-to-ship time (including door-to-needle time), ratio of number treated/total sent patients, adverse events/mortality during transfer, and mortality and modified Rankin scale at 90 days. Analysis of non-treated patients was also done.

Results

Seventy-eight patients were included; 16/78 patients were sent for endovascular therapy alone, and 62/78 for “drip-and-ship”; 12 patients were not treated. Door-to-ship, and door-to-needle times (mean ± SD) were 105 ± 29.8 and 62.5 ± 37.5 min, respectively. The ratio number of treated/total sent patients was 0.85. At 90 days, the global mortality rate was 21%, and 40% of patients showed favorable outcome. The main cause of non-treatment was spontaneous recanalization.

Conclusions

The high value for treated/total sent patients’ ratio underlines that “drip-and-ship” teleconsultation model is appropriate and effective, with a few untreated patients. The model is safe, without adverse events during transfer. Taken together, our outcomes are in line with the previous reports. “Drip-and-ship” teleconsultation model is safe and effective in rural areas, allowing good selections and rapid treatments for stroke patients, based on the transfer from the primary to the comprehensive stroke center.

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Authors and Affiliations

  1. Azienda USL Toscana SUDEST, Dipartimento Cardio Neuro Vascolare, UOC Neurologia, Grosseto, Italy

    Simone Gallerini, Manuele Bartalucci, Eleonora Innocenti, Caterina Marotti, Sergio Pieri, Katrin Plewnia, Chiara Scarpini & Roberto Marconi

  2. Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, 260 Stetson Street, Cincinnati, OH, 45219, USA

    Luca Marsili & Elizabeth G. Keeling

  3. Azienda USL Toscana SUDEST, Accettazione e Pronto Soccorso, UOC Medicina e Chirurgia d’Urgenza, Grosseto, Italy

    Vincenzo Groccia, Massimo Gregorio, Simone Geraci & Mauro Breggia

  4. Azienda USL Toscana SUDEST, Dipartimento Diagnostica per Immagini, UOSD Neuroradiologia-Grosseto, Grosseto, Italy

    Mauro Zocchi, Marco Cirinei, Teresa De Stefano & Stefania Galassi

  5. UOC Stroke Unit, AOU Senese, Siena, Italy

    Giuseppe Martini & Rossana Tassi

  6. UOS Neurointerventistica, UOC NINT, AOU Senese, Siena, Italy

    Sandra Bracco

  7. UOC Neuroimmagini e Neurointerventistica, AOU Senese, Siena, Italy

    Alfonso Cerase

  8. UF CO 118 SI-GR, Grosseto, Italy

    Stefano Dami & Giuseppe Panzardi

Authors
  1. Simone Gallerini
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  2. Luca Marsili
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  3. Vincenzo Groccia
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  24. Roberto Marconi
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Corresponding author

Correspondence to Luca Marsili.

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Gallerini, S., Marsili, L., Groccia, V. et al. Appropriateness, safety, and effectiveness of “drip and ship” teleconsultation model in Southeastern Tuscany: a feasibility study. Neurol Sci 41, 2961–2965 (2020). https://doi.org/10.1007/s10072-020-04446-x

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