Abstract T P249: Improving Door to Needle Times With Emergency Medical Services Collaboration

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kimberly M Smith ◽  
Susan M Gaunt
Keyword(s):  
Emergency Medical Services ◽  
Performance Improvement ◽  
Process Improvement ◽  
Patient Flow ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Care ◽  
Small Sample ◽  
Medical Services ◽  
Improvement Strategy ◽  
Emergency Medical

Background and Purpose: The AHA/ASA Stroke Guidelines recommend intravenous Recombinant Tissue Plasminogen Activator (rtPA) within 60 min from hospital arrival in eligible patients. Patient outcomes are time dependent and require a multidisciplinary approach between the hospital and Emergency Medical Services (EMS). In 2012, we implemented a process improvement initiative that included pre-hospital EMS lab draws, emergency department (ED) patient flow changes, immediate physician evaluation and EMS direct transport to CT. The purpose of this project was to improve stroke care by minimizing door to needle time (DTN) in patients with acute ischemic stroke. Methods: We used the Plan-Do-Check-Act method of performance improvement in our implementation process. A multidisciplinary performance Improvement team was established which included EMS, ED Laboratory, and Imaging participants. The four highest volume EMS stations were chosen to participate in the pilot process improvement strategy. Education was provided to EMS, ED physicians and staff, radiology, laboratory and patient registration personnel. Concurrent review of 100% of the stroke alert cases was conducted. We analyzed the door to CT result, the door to laboratory result and the DTN time for the four pilot stations. Based on the results, the decision was made to extend this process countywide. Results: Twenty-nine patients were enrolled in the pilot, and 15 labs were successfully drawn in the field for an average door to result time of 30.4 min. Fourteen labs were drawn on arrival for an average of 46.6 min. The door to CT result for the patients sent directly to CT by EMS was an average of 16 min. Seven out of the 29 patients were diverted to a room, and their average door to result was 30.6 min. Four patients received IV rtPA with an average DTN time of 47 min, and 100% of the 4 patients received IV rtPA within 60 min. During the same time period, IV rtPA was given to 9 patients that were not in the pilot for an average DTN of 61 min, and only 5/9 (55%) received IV rtPA within 60 min. Conclusion: The performance improvement initiative decreased our door to lab result, door to CT result and DTN time in this small sample and was implemented county wide.

scholarly journals Emergency Medical Services Capacity for Prehospital Stroke Care in North Carolina

2013 ◽  
Vol 10 ◽  
Author(s):  
Mehul D. Patel ◽  
Jane H. Brice ◽  
Kelly R. Evenson ◽  
Kathryn M. Rose ◽  
Chirayath M. Suchindran ◽  
...  
Keyword(s):  
North Carolina ◽  
Emergency Medical Services ◽  
Stroke Care ◽  
Medical Services ◽  
Emergency Medical

Abstract TP268: Utilization and Appropriateness of Emergency Medical Services Air Transport in Acute Ischemic Stroke Care

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Ashley Petrone ◽  
Martha Power ◽  
Debra Daniels ◽  
Michelle Large ◽  
Amelia Adcock
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Emergency Medical Services ◽  
Stroke Care ◽  
Air Transport ◽  
Medical Services ◽  
Emergency Medical

Abstract WP287: Emergency Medical Services Providers’ Knowledge of Prehospital Stroke Care and Recommendations for Feedback

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Timmy Li ◽  
Sneh Preet Munder ◽  
Anisha Chaudhry ◽  
Rima Madan ◽  
Michele Gribko ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Stroke Care ◽  
Medical Services ◽  
Emergency Medical

Abstract 86: Accuracy of Emergency Medical Services Dispatcher and Provider Recognition of Stroke in Clinical Practice

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Judy Jia ◽  
Michael Abboud ◽  
William Pajerowski ◽  
Michelle Guo ◽  
Guy David ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Emergency Medical Services ◽  
Stroke Care ◽  
Medical Services ◽  
Symptom Duration ◽  
Emergency Medical ◽  
Cerebrovascular Events ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Ischemic Attack

Objective: It is imperative that prehospital providers accurately recognize stroke. We assessed the sensitivity of stroke recognition by emergency medical services (EMS) in clinical practice in a major US city, and assessed variables associated with failure to recognize stroke. Methods: Data from the Philadelphia EMS system was linked with data from a single comprehensive stroke center to identify patients diagnosed with transient ischemic attack, ischemic stroke, or intracerebral hemorrhage by EMS dispatchers, EMS providers, or at hospital discharge between September 2009 and October 2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression was used to identify variables associated with EMS recognition of stroke. Results: There were a total of 709 cases, 400 of which were cerebrovascular events (38% infarct, 10% ICH, and 8% TIA). Of these cases, 80 (20%) were not recognized by EMS dispatcher or EMS provider, 90 (23%) were recognized by dispatcher alone, 87 (22%) by EMS provider alone, and 143 (36%) by both. EMS providers recognized stroke with a sensitivity of 58%, PPV 69%. Dispatchers or EMS providers recognized stroke with a sensitivity of 80%, PPV 51%. In a multivariable model, EMS providers were more likely to miss a stroke when NIHSS was low (compared to NIHSS 10+, NIHSS 5-9 OR=1.6, 95% CI 0.9-3.0 & NIHSS<5 OR=4.6, 95% CI 2.7-7.9), when motor signs were absent (OR=2.4, 95% CI 1.5-3.9), and when symptom duration was > 270 minutes (OR=2.4, 95% CI 1.5-3.8). Medics correctly recognized 81% of stroke patients with NIHSS>4 and symptom duration <270 minutes, and dispatcher or EMS providers correctly recognized 90% of these patients. Conclusions: EMS recognized stroke with limited sensitivity, resulting in a high proportion of missed stroke cases. When added to the EMS provider impression, dispatcher impression meaningfully improves the sensitivity for recognizing stroke. Maximizing sensitivity is critical to prehospital interventions which may improve overall stroke care, such as transportation to designated stroke centers or EMS prenotification of receiving hospitals.

Abstract T P349: Pre-Hospital Notification by Emergency Medical Services and Improved Stroke Care

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Tracy Love ◽  
Jessica Schneiderman
Keyword(s):  
Ct Scan ◽  
Emergency Medical Services ◽  
Stroke Patient ◽  
Early Recognition ◽  
Fire Department ◽  
Stroke Care ◽  
Medical Services ◽  
Emergency Medical ◽  
Scan Time ◽  
Stroke Team

Background: In rural settings, distance is a factor when medical assistance is critical. Every minute can make a difference in treatment and recovery of a stroke patient. Early recognition and notification of a possible stroke are key elements in the chain of survival for stroke victims. Emergency Medical Services (EMS) involvement in pre-hospital notification of a stroke patient can improve assessment and diagnostic times and use of alteplase. Purpose: The purpose of this study was to compare times of specific assessments, diagnostics, and treatments with EMS stroke alert activation prior to arrival compared to stroke alert activation by hospital personnel after patient arrival. Methods: In the setting of a rural, community hospital, the local fire department/paramedics were trained to use a screening tool and to provide pre-hospital activation of a stroke alert. The trial demonstrated positive results. Subsequently, education was disseminated to EMS providers throughout the five county service area. Data was collected from January to December 2013, with 30 alerts activated by Emergency Department (ED) personnel and 22 activated by EMS pre-hospital (n=52). Data consisted of times from door to: physician, Computer Tomography (CT) scan, CT read, laboratory, stroke team, decision for alteplase, and needle time. Results: The average time from door to physician yielded a decrease by 13 minutes for an EMS alert compared to ED alert. Average door to CT scan time were decreased by 6 minutes using the EMS alert. Average times from door to laboratory completion decreased by 5 minutes using the EMS alert. Average time for door to stroke team was decreased by 9 minutes using the EMS alert. Door to needle times did not differ between groups, but the percentage of patients receiving alteplase increased in the EMS alert group (18.2% with EMS alert compared to 3.3% with an ED alert). Conclusion: In conclusion, the findings of this study suggest times for assessment are improved through EMS pre-notification and early initiation of the hospital stroke-alert system. It also shows an increase in the use of alteplase when there is pre-hospital notification of a potential stroke patient.

Analysis of stroke care among 2019-2020 national emergency medical services information system encounters

2022 ◽  
Vol 31 (3) ◽  
pp. 106278
Author(s):  
Layne Dylla ◽  
John D. Rice ◽  
Sharon N. Poisson ◽  
Andrew A. Monte ◽  
Hannah M. Higgins ◽  
...  
Keyword(s):  
Information System ◽  
Emergency Medical Services ◽  
Stroke Care ◽  
Medical Services ◽  
Emergency Medical ◽  
National Emergency

Abstract 2721: Probabilistic Matching of Computerized Emergency Medical Services (EMS) records and Emergency Department and Patient Discharge Data: a Novel Approach to Evaluation of Prehospital Stroke Care

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Prasanthi Govindarajan ◽  
Larry Cook ◽  
David Ghilarducci ◽  
S C Johnston
Keyword(s):  
Emergency Department ◽  
Emergency Medical Services ◽  
Patient Discharge ◽  
Stroke Care ◽  
Medical Services ◽  
Matched Pairs ◽  
Match Probability ◽  
Discharge Data ◽  
Emergency Medical ◽  
Probabilistic Linkage

Background and Purpose: Emergency Medical Services is an important element of acute stroke care. However, evaluation of prehospital stroke care is limited by lack of exchange of patient outcome data between hospitals and emergency medical services (EMS) agencies. In this study, we describe and demonstrate the feasibility of linking county wide patient level ambulance data with emergency department (EDD) and patient discharge data (PDD) using a probabilistic matching algorithm. Methods: Probabilistic linkage was used to match county-wide ambulance data from 2005-2007 to hospital (EDD and PDD) records with a final ICD -9 diagnosis of stroke (430-436). The linkage model was based on the patient’s transport/admission date, date of birth, race, sex, county of residence, and destination hospital. Probabilistic linkage was performed using LinkSolv version 8.29746 which calculates the probability that a pair of records is a true match based on agreement/disagreement patterns of the linkage variables. Pairs of records with a match probability of 0.8 or higher were considered true matches. All other pairs were false matches and rejected. Results: During 2005 - 2007 there were 310,731 patients transported to a facility in county and 34,785 hospital records with a diagnosis of stroke. Using the linkage algorithm we identified 11,473 (33%) matches with EMS records. Linkage rates increased each year with 30%, 34%, and 36% of hospital patients matching EMS record for 2005, 2006, and 2007 respectively. The median match probability was 0.993 and the IQR was 0.974 to 0.9996. By taking the compliment of the match probability we estimate our linked sample to include 255 (2%) false matches. Date of treatment/admission and the patient’s sex were observed to be the most reliable, disagreeing on less than one percent (1%) of all matched pairs. Patient’s zip code was the least reliable, disagreeing on one third of matched pairs. Conclusions: Our study demonstrates that probabilistic matching can be used to create a comprehensive patient care record which in turn can provide opportunities for researchers to study different phases of stroke care.

Helicopter emergency medical services and stroke care regionalization: measuring performance in a maturing system

2007 ◽  
Vol 25 (2) ◽  
pp. 158-163 ◽  
Author(s):  
Wendy Macias Konstantopoulos ◽  
John Pliakas ◽  
Christine Hong ◽  
Katie Chan ◽  
Gina Kim ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Stroke Care ◽  
Medical Services ◽  
Helicopter Emergency Medical Services ◽  
Emergency Medical
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