1. Let’s hear it for the Band. What does the data say
Let’s hear it for the Band! What does the data say? An update on stroke wrist bands in Arkansas
Aliza Brown, PhD, FAHA
Assistant Professor, Department of Neurology
Institute for Digital Health & Innovation, Stroke Program Lead Evaluator
University of Arkansas for Medical Sciences

2. Disclosures
I declare no financial relationships to disclose that relate to this program. *Note that AR SAVES is noted as IDHI-SP
UAMS, IDHI Stroke Program

3. Bands Who receives a stroke band?
Those patients who test positive on a recognized stroke scale
EMT/Paramedic role: following positive assessment by validated exam, record the ID# number on their ePCR*
Hospital role: ensure all positive suspected strokes have a band and record ID# into ASR/GWTG and if IDHI-SP hospital the ID# is entered into the EPIC data system
UAMS, IDHI Stroke Program

4. Importance
Without using patient identifiers such as “patient names” there are no direct links between hospital data and EMS data in Arkansas
Without creating this link we lose the ability to assess pre-hospital care among stroke cases.
With the band ID#s we can merge de-identified data bases and gain invaluable information,
including …
UAMS, IDHI Stroke Program

5. Why Band? Link stroke cases to EMS data systems
Improve ability to manage, monitor and assess
Track patient Door OUT to Door IN time
UAMS, IDHI Stroke Program

6. EMS Numbers and more numbers …
658 stroke consults - EMS transport to spoke hospitals
622 stroke consults - self-transported (privately owned vehicle [POV]).
Patients transported by EMS were significantly older vs. POV consults
Patient Age
60.9
UAMS, IDHI Stroke Program

7. The EMS difference … so why Band?
EMS transports were also associated with higher deficits vs. POV consults
Patient Deficits
(NIHSS)
7.8
UAMS, IDHI Stroke Program

8. How are we collecting band data ?
EMS
ASR/
GWTG
AR SAVES
Increased teamwork between EMS, IDHI-SP and ASR/GWTG ensuring positive suspected Stroke cases receive bands and the band ID#s are uploaded.
Before we can utilize new and current data based on the wrist band linkages, their percentage of usage must be determined….
UAMS, IDHI Stroke Program

9. Banding Methods EMS Hospitals AR SAVES and GWTG
Following examination of suspected cases of stroke,
Positive assessment of primary impression of “Stroke” a band is placed on the patients wrist
Band ID# are entered into the paramedic’s ePCR
Bands are left on patient until discharged home
Every EMS agency enters all EMS run data into ePCR programs
All agencies send their ePCR data to the Arkansas Department of Health data system, Image Trend Elite
Hospitals AR SAVES and GWTG
IDHI-SP Call Center records video stroke consult information from 54 hospitals (including band IDs into EPIC)
At 60 ASR participating hospitals in Arkansas, all stroke cases are entered into the GWTG database
The Arkansas Department of Health provides funding to American Data Network, an outside agency to abstract stroke data into GWTG
Stroke patients without a band will have one placed by hospital staff in ED and ID# recorded
Stroke patients arriving by POV* will have a band placed
UAMS, IDHI Stroke Program

10. January – May 2019 Integrating Data Systems
IDHI-SP indicates higher numbers of stroke bands placed by ED staff
Bands placed by ED staff could encompass both POV and EMS transported patients
#Stroke bands have increased over last five months
UAMS, IDHI Stroke Program

11. Pre-hospital Triage Exam Results
Positive Tests for Stroke Assessment:
Approximately half had a stroke band
Pre-Notification to Destination Hospitals:
More than half had a stroke band (58% vs. 40%)
UAMS, IDHI Stroke Program

12. 2018 to 2019
%Band ID usage by EMS using three digit code
28%
20%
11%
51%
Percent of Arkansas Counties who’s EMS utilized stroke bands
48% %
57%
36%
38%
24%
56%
Big Improvement!
22%
%Band
usage
2019
29%
39%
51%
UAMS, IDHI Stroke Program

13. Why are Bands and EMS transports Important?
7 min!
EMS transport of strokes to area hospitals can result in a 7 minute improvement in Door to CT screening:
Each minute is critical !
1 minute = 1.9 million neurons
7 minutes = 13.3 million neurons SAVED!
How does the stroke band placement ‘fit’ with improved treatment?
They are associated with a greater improvement in time of 14 minutes
14 minutes = 26.6 million neurons SAVED!
Stroke Wrist Bands
14 min!

14. Q: Does who places the band influence the Door to treatment time?
Ans: Yes!
UAMS, IDHI Stroke Program

15. Jan to May, 2019 at a glance … 95% EMS = 39% ED = 61% Data Base
Total #Entries
Total #Band ID
%Placement
%Match to EMS Database
EMS
1,616
652
40% -
IDHI-SP
636
602
95%
37%
EMS = 39%
ED = 61%
ASR/GWTG
4,668
1,970
42%*
8.4%
UAMS, IDHI Stroke Program

16. In Conclusion
2019 data from Hospital ED staff would be improved to know who (EMS or ED Staff) placed the bands
Stroke bands placed by EMS were associated with:
increased Pre-Notification to destination hospitals
improved treatment time
Increase training for band placement in zip code regions with low usage
UAMS, IDHI Stroke Program

17. Thank you,
… Questions?
UAMS, IDHI Stroke Program