Journal of Stroke and Cerebrovascular Diseases
Original ArticleThe Quality of Prehospital Ischemic Stroke Care: Compliance with Guidelines and Impact on In-hospital Stroke Response
Introduction
Emergency medical services (EMSs) play a critical role in acute stroke response. Transportation of stroke patients by EMS has been associated with earlier arrival,1, 2, 3, 4, 5, 6 faster evaluation,5, 7 increased utilization of thrombolytic therapy (tissue-plasminogen activator [t-PA]),8 and reduced door-to-needle times for thrombolytic administration.5, 9 To standardize and advance the quality of prehospital stroke care, the American Stroke Association (ASA) has issued recommendations regarding best practices for prehospital stroke care including clinical elements, such as performance of a prehospital stroke scale, as well as targets for time-related variables such as response time and on-scene time.10, 11 However, little research has been conducted to determine how effectively these recommendations have been translated into practice or if compliance with these recommendations impacts patient outcomes.
The purpose of this study was to quantify compliance with EMS performance measures in a cohort of confirmed ischemic stroke patients and to examine the relationship between compliance with EMS performance measures and in-hospital stroke response.
Section snippets
Setting
This is an observational cohort study of patients with ischemic stroke transported by EMS to 2 primary stroke center hospitals over a 1 year period (April 2012 through March 2013). The study was conducted in Kent County, a single, predominantly urban, Michigan county with a population of about 600,000. The county is served by 4 acute care hospitals, all of which are primary stroke centers. Two hospitals, representing a combined 1100 inpatient beds and over 130,000 adult emergency department
Results
The characteristics of the study subjects are summarized in Table 2. Over 12 months, 188 confirmed ischemic stroke patients were transported by EMS. EMS records were not found for 2 patients, leaving 186 EMS transported patients for analysis (Fig 1). Inter-rater agreement for the final diagnosis of stroke was high (κ = .86). The median age was 79 years, 58% were female, median NIHSS score was 7, 48% arrived within 120 minutes of symptom onset (time of onset could not be determined in 44 of 186
Discussion
Many observational studies have reported associations between EMS utilization and favorable in-hospital care as well as better clinical outcomes for stroke patients.1, 2, 3, 4, 5, 6, 7, 8 Presumably, these benefits stem from earlier stroke recognition, expedited transport, and early activation of stroke teams before arrival at hospital. To promote these goals, the ASA has endorsed a variety of prehospital quality measures for stroke.11 This study assembled a prospective consecutive sample of
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Cited by (44)
Analysis of stroke care among 2019-2020 national emergency medical services information system encounters
2022, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :The reasons behind this difference in on-scene time are unknown and may reflect underlying differences in patient presentations. These nationwide practice patterns were also reflected in prior studies in Michigan, where less than 50% of all ischemic strokes presenting via EMS had on-scene times of less than 15 min on-scene.21 In other areas of stroke care, the findings in Michigan reflected higher compliance with ASA guidelines compared to the nationwide practices reported here.
AC-AC: Dynamic revocable access control for acute care teams to access medical records
2021, Smart HealthCitation Excerpt :Researchers have shown that the sooner the treatment is given, the better the functional outcomes for the patient (Saver, 2006). Moreover, patient transportation at the highest priority and hospital notification before patient arrival were associated with faster stroke care (Oostema et al., 2014). Emergency treatments usually request a complex collaboration of various healthcare organisations.
Prehospital time intervals and management of ischemic stroke patients
2021, American Journal of Emergency MedicineCitation Excerpt :Nationally, <15% of ischemic stroke patients receive tPA [1-6]. Approximately 50% of stroke patients arrive to the emergency department (ED) via emergency medical services (EMS), and patients who arrive via EMS are more likely to receive tPA and have better outcomes [7-20]. EMS providers have the ability to prenotify EDs of an incoming stroke patient, which prompts the ED to prepare for the patient's arrival.
A Comparison of Probabilistic and Deterministic Match Strategies for Linking Prehospital and in-Hospital Stroke Registry Data
2020, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Previous studies have linked the use of a prehospital stroke scale to more accurate EMS stroke recognition,3–5 and increased hospital prenotification to substantial reductions in evaluation and treatment times.6–8 However, the quality of EMS care is variable8–10 and challenging to systematically measure. To promote high quality prehospital stroke care, various EMS practices have been recommended,1 however data sources to assess, monitor, and improve prehospital stroke care are limited.
Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care
2018, Prehospital and Disaster Medicine
Grant Support: Blue Cross Blue Shield of Michigan Foundation. (1822.11)