English
JapaneseIn the fast-paced medical field, “coordination” is what determines a patient’s prognosis.
Stroke treatment is often described as “Time is Brain.” In a world where a one-minute delay can determine the severity of the after-effects, what makes the difference is not the diagnostic technique itself, but how quickly and accurately the multidisciplinary team can collaborate. The first installment of this series begins with this often-overlooked topic: “collaboration.”
The technology to save patients is in place. However, the mechanisms to “make time” for using that technology are not keeping pace – this is a reality that all medical settings, which operate under tight time constraints, face.
In the treatment of acute stroke, there are two reperfusion therapies whose effectiveness is directly linked to the time elapsed since the onset of symptoms. tPA (alteplase intravenous therapy), which dissolves blood clots, must be administered within 4 hours and 30 minutes of symptom onset, and global clinical guidelines recommend initiating it within one hour of arrival at the hospital. However, even with tPA alone, approximately 40 evaluation items must be confirmed across multiple departments. This is not a problem that can be solved by a single expert; it requires emergency physicians, nurses, radiologists, laboratory technicians, pharmacists, and specialists to work in parallel on the same timeline.
Time is quietly slipping away.
4 hours
30 minutes
The time limit from the onset of symptoms during which tPA administration is possible. The therapeutic effect rapidly decreases over time.
Approximately 40 items
Clinical tasks that must be confirmed by multiple departments before tPA is implemented. Many of these tasks require parallel processing.
Within
1 hour
The goals recommended by the guidelines from the time of hospital visit to the start of treatment are extremely difficult to achieve without coordination.
Delays arise not from “ability” but from “coordination”.
Much of the delay on the ground is not due to a lack of skill on the part of individual medical professionals. It stems from structural issues in information transmission between teams. There are three typical failures in traditional telephone-based communication.
Task 1
Information distortion (telephone game)
Information changes slightly with each pass from the first person to the specialist. Important findings are omitted, and the basis for diagnosis collapses.
Task 2
I don’t know their contact information.
The on-call staff changes frequently, and the contact network can’t keep up with updates. The time spent figuring out “who to call” directly translates into delays.
Task 3
Unable to connect/unable to leave
If a specialist is in the middle of a procedure, busy, or has their phone turned off, you won’t be able to reach them when you need them most. Even a single missed call can cause a critical delay.
Figure 1: Telephone relay-type collaboration (left) and real-time collaboration that delivers the situation to everyone simultaneously (right). The latter allows the entire team to share “who is at what stage now” on the same screen, eliminating the need for messages and phone calls themselves.
From “communicating quickly” to “seeing simultaneously”
To solve these challenges, we need not faster phone calls, but a change in the assumptions surrounding collaboration. The key lies in these two design principles:
Simultaneous notification and status visualization
The system simultaneously notifies all relevant party’s smartphones of the onset of symptoms, patient arrival, and completion of treatment. The status of each task (awaiting confirmation/preparing/in progress/completed) is shared on a single screen, allowing for the next step to be taken without making phone calls.
Accelerating collaboration through AI
By layering AI on top of the collaborative platform, medical care that “starts preparation before arrival” becomes a reality, including pre-triage based on information from paramedics, automatic detection of major vessel occlusion from head CT and MRI images, and optimization of transport destinations.
The role of technology is not to replace medical professionals. It is to free up even a single second for decisions that only humans can make.
Improved collaboration will be reflected in the numbers.
The fact that this “redesign of collaboration” can change prognosis has been reported academically from the medical field in Japan. An observational study published in the medical journal “Modern Medicine” (2024) by the stroke team at Fujita Health University quantitatively demonstrates the effectiveness of using ICT to support team collaboration.
Figure 2: Time from hospital arrival to initiation of tPA administration. The time was reduced by 10.2 minutes, from 58.0 minutes before initiation to 47.8 minutes after initiation (p<0.001). It is also suggestive that a significant improvement was already observed during the “preparation period” when the team was assembled.
Published Research
ICT-based support for team collaboration and treatment time for acute stroke
In an observational study (2018-2020) involving 316 patients across four facilities, not only was the time from hospital arrival to tPA administration reduced, but the time from hospital arrival to the start of mechanical thrombectomy was also shortened from 93.8 minutes to 88.5 minutes (p=0.004). Furthermore, functional prognosis at discharge was significantly improved (p=0.003).
−10.2 minutes
tPA: Visit → Start treatment
−5.3 minutes
Thrombectomy: Visit the hospital → Start of treatment
p=0.003
Improvement in functional prognosis at discharge
Source: Matsumoto et al., “Team-Based Medical Support Utilizing ICT in Acute Stroke Treatment,” Gendai Igaku (Modern Medicine), Vol. 71, No. 2 (2024). This article cites a published academic paper and does not indicate any relationship between a specific medical institution and Cubastion.
Collaboration is essential for all time-constrained medical care
The “Time is Brain” structure is not limited to stroke. Myocardial infarction, trauma, obstetric emergencies, sepsis – the same challenges and potential exist in all situations where time is crucial to the prognosis and multiple professions must work simultaneously. Next time, we will focus on the “people” who support these situations and discuss reforms to doctors’ working styles and the reduction of their workload through AI.
