Abstract TMP82: Community Education-Impact of Knowing Your Sign

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kristin Peterson ◽  
Victoria Steinkoenig
Keyword(s):  
Emergency Department ◽  
Symptom Onset ◽  
Arrival Time ◽  
Community Education ◽  
Treatment Options ◽  
The United States ◽  
Medical Attention ◽  
Post Intervention ◽  
Stroke Treatment ◽  
To Receive

Stroke remains one of the leading causes of death and disability in the United States. Even with increased community education on stroke, the most common reason for delay in seeking medical attention is lack of recognition of the signs, symptoms and time sensitivity of stroke treatment. It is compelling to see the amount of patients that do not present for emergency treatment within three hours of symptom onset. This lack of awareness and delay in arrival was found to contribute to decreased candidacy for stroke treatment and leads to increased chances of disability. The critical need for community partnerships specifically aimed at educating on recognition of stroke signs, symptoms and treatment options was identified. The goal of this project was to demonstrate the correlation between community education and decreasing symptom onset to door time. Method: This retrospective study performed at a Central Illinois hospital reviewed data including symptom onset to door times from January 2014 to March 2015 as one method of determining the effectiveness of community education. Intervention time frames were held between April 2014 to December 2014 with a 3 month pre and post intervention phase. Inclusion criteria: any stroke code that presented through triage or via EMS. Exclusion criteria: in house stroke codes and symptom onset that was unknown. Results: In the first quarter of 2014, the average time it took patients to present to the Emergency Department from symptom onset was 233 minutes. Post-implementation data revealed the average symptom onset to door time was 63 minutes which accounts for a nearly 73% decrease in arrival time. Conclusion: Over 20 Community Education sessions on stroke signs, symptoms and the importance of seeking prompt medical attention were held over a nine month period. This community education on stroke was effective because there was a decrease in stroke symptom onset to the Emergency Department which created more eligible patients to receive emergency stroke treatment. This study validated that by providing intense community education aimed at the recognition of stroke signs, symptoms and treatment options, more patients were eligible to receive emergent stroke treatment because the arrival time was drastically shortened.

Abstract WP178: Acute Stroke Ischemic Symptom Onset-to-Arrival Time in Michigan Hospitals

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Muhammad U Farooq ◽  
Kathie Thomas
Keyword(s):  
African American ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Patient Outcomes ◽  
Symptom Onset ◽  
Arrival Time ◽  
Heart Association ◽  
The United States ◽  
Stroke Patients ◽  
White Patients

Objectives: Stroke is the fifth-leading cause of death and the leading cause of disability in the United States. One of the primary goals of the American Heart Association/American Stroke Association is to increase the number of acute stroke patients arriving at emergency departments (EDs) within 1-hour of symptom onset. Earlier treatment with thrombolysis in patients with acute ischemic stroke translates into improved patient outcomes. The objective of this abstract is to examine the association between the use of emergency medical services (EMS) and symptom onset-to-arrival time in patients with ischemic stroke. Methods: A retrospective review of ischemic stroke patients (n = 8873) from 25 Michigan hospitals from January 2012-December 2014 using Get With the Guidelines databases was conducted. Symptom onset-to-ED arrival time and arrival mode were examined. Results: It was found that 17.4% of ischemic stroke patients arrived at the hospitals within 1-hour of symptom onset. EMS transported 69.1% of patients who arrived within 1-hour of symptom onset. During this 1-hour period African American patients (22%) were less likely to use EMS transportation as compared to White patients (72%). The majority of patients, 41.8%, arrived after 6-hours of symptom onset. EMS transported only 40% of patients who arrived after 6-hours of symptom onset. As before, during this 6-hour period African American patients (20%) were also less likely to use EMS transportation as compared to White patients (75%). Symptom onset-to-ED arrival time was shorter for those patients who used EMS. The median pre-hospital delay time was 2.6 hours for those who used EMS versus 6.2 hours for those who did not use EMS. Conclusions: The use of EMS is associated with a decreased pre-hospital delay, early treatment with thrombolysis and improved patient outcomes in ischemic stroke patients. Community interventions should focus on creating awareness especially in minority populations about stroke as a neurological emergency and encourage EMS use amongst stroke patients.

Abstract 3097: Acute In-hospital Stroke: How Do We Do Compared To Strokes In The Emergency Department?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Dolora Wisco ◽  
Christopher Newey ◽  
Pravin George ◽  
James Gebel
Keyword(s):  
Emergency Department ◽  
Time Window ◽  
Stroke Treatment ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tertiary Center ◽  
Neuro Imaging ◽  
One Year ◽  
To Receive ◽  
Iv Tpa ◽  
Arterial Thrombolysis

Introduction: Intravenous tissue plasminogen activator (IV tPA) has been approved for treating strokes up to 3 hours after onset of symptoms and may be beneficial up to 4.5 hours in patients who qualify. Additionally, neuro-intervention, i.e., intra-arterial thrombolysis or thrombectomy, is also an approved treatment option. Population studies show that 6% receive IV tPA within 3 hours of stroke onset. However, in-hospital strokes present challenges to treating within an adequate time. We present here our experience with in-hospital strokes, treatments, and identifiable delays in treatments. Methods: Single, tertiary center retrospective study of 55 in-hospital strokes over a one-year period from January 2009 to January 2010, and strokes in the Emergency Department over 6 month period from January 2010 to June 2010. Results: Twenty-nine in-hospital strokes were evaluated within 3 hours of symptoms onset. Two (6.9%) received IV tPA, and four (13.8%) received neuro-intervention (either intra-arterial thrombolysis or thrombectomy). None of the patients who presented greater than 3 hours after symptom onset was treated with any treatment (n=28). When compared to patients who present to the ED within 3 hours, in-hospital strokes were less likely to get IV tPA (6.9% vs. 20.8%), and they were more likely to receive neuro-intervention (13.8% vs. 10.3%). Neuro-intervention was performed on 9.09% of all in-hospital strokes (1 of 5 presented beyond the 3 hour time window). For in-hospital strokes that receive any treatment within 3 hours, the average time to neurology evaluation, to CT, and to treatment are 35 min, 68 min, and 237 min, respectively. For strokes in the Ed, the average time to evaluation, to CT, and to treatment are 90 min, 28 min, and 66 min respectively. The delay for in-hospital strokes is in obtaining the CT and initiating the treatment. Discussion: In-hospital stroke patients wait longer than their ED counterparts to be taken to CT and to receive stroke treatment. They are also less likely to receive IV tPA, and more likely to receive neuro-intervention. The longer time to neuro-imaging and thrombolytic treatment may reflect the fact that patients suffering in-hospital strokes have more complex medical co-morbidities that must be taken account during the evaluation and administration of thrombolytic therapy.

Abstract W P340: Emergency Department Nurses Collaborate With Long Term Care Facilities for Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jamie L Strom
Keyword(s):  
Emergency Department ◽  
Long Term Care ◽  
Stroke Patients ◽  
Term Care ◽  
Stroke Treatment ◽  
Emergency Department Nurses ◽  
Senior Services ◽  
To Receive ◽  
Education Initiative

Background and Purpose: Stroke treatment is often delayed before patients reach the emergency department (ED). Some patients arrive in time to receive medication that can reverse new stroke symptoms. Some are not as fortunate. They are either admitted to the palliative unit, or discharged only to live with their new disabilities possibly for the rest of their lives. In 2013, nurses observed many long term care (LTC) patients were not getting to the ED in time to receive tPA (tissue plasminogen activator), a medication used to reverse stroke symptoms. The purpose of this process improvement was to increase the number of LTC patients with stroke symptoms arriving in the ED within the tPA window. Methods: To determine how many patients from nursing homes were missing the tPA window, data from the ED’s records was abstracted from the month of June 2013. The sample size was all patients who presented with possible stroke symptoms, and who were also from LTC facilities. Surprisingly, 100% of LTC patients presenting with stroke symptoms missed the tPA window. With the support of ED leadership, we decided to raise awareness about the tPA window in the LTC facilities. No evidence existed from ED’s related to LTC patients and the tPA window. Approximately 1,000 unused stroke pamphlets were collected. A PowerPoint presentation based on AHA guidelines was used. A lecture occurred at the community’s senior services meeting, and many LTC administrators were willing to adopt this education initiative at their facilities. ED staff became involved and helped conduct the in-services. In exchange for their volunteering, they received credit to help with career ladders at their hospital. Results: The number of possible stroke patients from LTC facilities getting to the ED within eight hours of the last time seen normal (LTSN) has increased from 0% in June 2013, to 25% in March 2014. Conclusions: Stroke education teams of ED nurses showed improvement in LTC patients arriving in the ED within the tPA window. In conclusion, it is encouraged that other ED staff volunteer to teach in LTC facilities in their own communities, in assisting their stroke patients as well.

Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis

Neurology ◽  
2017 ◽  
Vol 88 (14) ◽  
pp. 1305-1312 ◽  
Author(s):  
Ather Taqui ◽  
Russell Cerejo ◽  
Ahmed Itrat ◽  
Farren B.S. Briggs ◽  
Andrew P. Reimer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Symptom Onset ◽  
Control Group ◽  
Stroke Severity ◽  
Thrombolytic Treatment ◽  
Treatment Unit ◽  
Stroke Treatment ◽  
Ct Data ◽  
The Times ◽  
Completion Times

Objective:To compare the times to evaluation and thrombolytic treatment of patients treated with a telemedicine-enabled mobile stroke treatment unit (MSTU) vs those among patients brought to the emergency department (ED) via a traditional ambulance.Methods:We implemented a MSTU with telemedicine at our institution starting July 18, 2014. A vascular neurologist evaluated each patient via telemedicine and a neuroradiologist and vascular neurologist remotely assessed images obtained by the MSTU CT. Data were entered in a prospective registry. The evaluation and treatment of the first 100 MSTU patients (July 18, 2014–November 1, 2014) was compared to a control group of 53 patients brought to the ED via a traditional ambulance in 2014. Times were expressed as medians with their interquartile ranges.Results:Patient and stroke severity characteristics were similar between 100 MSTU and 53 ED control patients (initial NIH Stroke Scale score 6 vs 7, p = 0.679). There was a significant reduction of median alarm-to-CT scan completion times (33 minutes MSTU vs 56 minutes controls, p < 0.0001), median alarm-to-thrombolysis times (55.5 minutes MSTU vs 94 minutes controls, p < 0.0001), median door-to-thrombolysis times (31.5 minutes MSTU vs 58 minutes controls, p = 0.0012), and symptom-onset-to-thrombolysis times (97 minutes MSTU vs 122.5 minutes controls, p = 0.0485). Sixteen patients evaluated on MSTU received thrombolysis, 25% of whom received it within 60 minutes of symptom onset.Conclusion:Compared with the traditional ambulance model, telemedicine-enabled ambulance-based thrombolysis resulted in significantly decreased time to imaging and treatment.

scholarly journals Effect of emergency severity index implementation on the waiting time for patients to receive health services in the emergency department

2020 ◽  
Vol 37 (4) ◽  
pp. 369-380
Author(s):  
Akbar Sarvari ◽  
Hosein Habibzadeh ◽  
Leyla Alilu ◽  
Naser Sheikhi
Keyword(s):  
Emergency Department ◽  
Health Services ◽  
Waiting Time ◽  
Intervention Group ◽  
Simple Random Sampling ◽  
Severity Index ◽  
Emergency Severity Index ◽  
Post Intervention ◽  
Before And After ◽  
To Receive

The waiting time for patients in the emergency department to receive health services influences many processes in this department. This research aimed to determine the effect of implementation and deployment of emergency severity index (ESI) on the waiting time for patients to receive health services in the emergency department. This quasi-experimental study was performed on 736 patients who were referred to the emergency department of Imam Khomeini Hospital of Mahabad. For the ESI triage implementation, 368 patients were assigned to the pre-intervention group and 368 patients were selected for the post-intervention group, using a simple random sampling. Before and after the ESI triage implementation, the waiting time for patients to receive services was measured and recorded using a chronometer. For data analysis, Chi-square, Mann-Whitney and Kruskal-Wallis tests were used. Before and after the intervention, both groups were homogeneous in terms of demographic variables (p > 0.05). The results of Mann-Whitney test indicate that implementation of emergency severity index (ESI) has a positive effect on the decrease of average time intervals to provide health services, as well as on the entire length of stay in the emergency department (p < 0.05). Given the effect of the ESI triage implementation that reduced the waiting time for patients to receive health services, ESI is recommended for training nurses and other emergency staff.

Evaluation of Safe Streets Treatment Option to Reduce Recidivism Among Repeat Drunk Driving Offenders

2018 ◽  
Vol 30 (9) ◽  
pp. 1368-1384
Author(s):  
Tina L. Freiburger ◽  
Alyssa M. Sheeran
Keyword(s):  
Comparison Group ◽  
Treatment Options ◽  
Drunk Driving ◽  
The United States ◽  
Policy Implications ◽  
Future Research ◽  
Drinking And Driving ◽  
Repeat Offenders ◽  
Driving Behaviors ◽  
To Receive

Drinking and driving poses a significant issue in the United States. Repeat offenders are especially problematic as they are responsible for a high proportion of all drunk driving offenses and are more likely to continue in their drinking and driving behaviors. This study examines the effectiveness of the Safe Streets Treatment Options Program (SSTOP) in Outagamie County, Wisconsin, to reduce recidivism among repeat offenders. The results indicate that participants of SSTOP had significantly fewer convictions, fewer subsequent sentences to incarceration, were sentenced to fewer days incarcerated in jail for subsequent offenses, and were less likely to receive another Operating While Intoxicated (OWI) conviction than those in the comparison group. Policy implications and directions for future research also are discussed.

Multimodal therapy for the treatment of fatigue in patients with prostate cancer receiving androgen deprivation therapy and radiation.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. TPS9650-TPS9650
Author(s):  
Sriram Yennurajalingam ◽  
Cindy Carmack ◽  
Karen Basen-Engquist ◽  
James M. Reuben ◽  
Eduardo Bruera
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Androgen Deprivation Therapy ◽  
Inflammatory Cytokines ◽  
Depressed Mood ◽  
Treatment Options ◽  
Depression Scale ◽  
Androgen Deprivation ◽  
Post Intervention ◽  
To Receive

TPS9650 Background: Cancer-related fatigue (CRF) is the most frequently reported symptom associated with cancer and its treatment. Unfortunately, there are limited treatment options to alleviate this distressing symptom. Preliminary data suggest that the combination of exercise, cognitive behavioral therapy (CBT), and methylphenidate (that is, multimodality therapy [MMT]) can play an important role in reducing CRF. The project’s objective is to explore the effects and safety of this MMT on CRF in prostate cancer patients scheduled to receive radiotherapy with androgen deprivation therapy. We hypothesizethat the MMT is capable of reducing CRF as measured by the FACIT-F subscale in prostate cancer patients scheduled to receive radiotherapy. Specific Aims:(1) Our primary aim is to obtain preliminary estimates of the effects of various treatments (exercise, CBT, and methylphenidate) and their combinations in reducing CRF in prostate cancer patients receiving radiotherapy, as measured by the change in patients’ FACIT-F subscale scores taken at baseline and on day 57 and the secondary objective is to determine the effects of the treatments and their combinations on anxiety and depressed mood (both measured by the Hospital Anxiety Depression Scale [HADS]); on physical activity and function (measured by an accelerometer and a handgrip dynamometer, respectively); on levels of inflammatory cytokines (IL-1β, IL-6, TNF-α, and IL-10) in serum and induced monocytes, before and after treatment Methods: For this study, we will use a randomized factorial design to assess 3 treatments (exercise, CBT, and methylphenidate) and their placebos in 8 replications. A total of 32 patients will receive each primary treatment and 32 will not. Patients will be studied for a 57-day period, during which they are scheduled undergo daily radiation treatments with androgen deprivation therapy. Fatigue, anxiety and depressed mood, and inflammatory cytokines will be determined at baseline and at 3 subsequent post-intervention assessments. After successful initiation so far 19/64 patients were enrolled. Accrual continues. Clinical trial information: NCT01410942.

scholarly journals LO64: A systematic review of interventions to influence opioid prescribing from the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S30-S31
Author(s):  
M. Tran ◽  
C. Thompson ◽  
C. Walsh ◽  
S. McLeod ◽  
B. Borgundvaag
Keyword(s):  
Emergency Department ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Care Coordination ◽  
The United States ◽  
Post Intervention ◽  
Eligibility Criteria ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Data Transparency

Introduction: The opioid crisis has reached epidemic levels in Canada, driven in large part by prescription drug use. Emergency physicians are frequent prescribers of opioids; therefore, the emergency department (ED) represents an important setting for potential intervention to encourage rational and safe prescribing. The objective of this study was to systematically review the literature on interventions aimed to influence opioid prescribing in the ED. Methods: Electronic searches of Medline and Cochrane were conducted and reference lists were hand-searched. All quantitative studies published in English from 2009 to 2019 were eligible for inclusion. Two reviewers independently screened the search output to identify potentially eligible studies, the full texts of which were retrieved and assessed for inclusion. Outcomes of interest included opioid prescribing rate (proportion of ED visits resulting in an opioid prescription at discharge), morphine milligram equivalents per prescription and variability among prescribers. Results: The search strategy yielded 797 potentially relevant citations. After eliminating duplicate citations and studies that did not meet eligibility criteria, 34 potentially relevant studies were retrieved in full text. Of these, 28 studies were included in the review. The majority (26, 92.9%) of studies were based in the United States and two (7.1%) were from Australia. Four (14.3%) were randomized controlled trials. The interventions were classified into six categories: prescribing guidelines (n = 10), regulation/rescheduling of opioids (n = 6), prescribing data transparency (n = 4), education (n = 4), care coordination (n = 3), and electronic medical record changes (n = 1). The majority of interventions reduced the opioid prescribing rate from the ED (21/28, 75.0%), although regulation/rescheduling of opioids had mixed effectiveness, with 3/6 (50%) studies reporting a small increase in the opioid prescribing rate post-intervention. Education had small yet consistent effects on reducing the opioid prescribing rate. Conclusion: A variety of interventions have attempted to improve opioid prescribing from the ED. These interventions include prescribing guidelines, regulation/rescheduling, data transparency, education, care coordination, and electronic medical record changes. The majority of interventions reduced the opioid prescribing rate; however, regulation/rescheduling of opioids demonstrated mixed effectiveness.

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