scholarly journals Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients

2020 ◽  
Vol 9 (8) ◽  
pp. 2376
Author(s):  
Moritz Kielkopf ◽  
Thomas Meinel ◽  
Johannes Kaesmacher ◽  
Urs Fischer ◽  
Marcel Arnold ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Practitioner ◽  
Time Delay ◽  
Emergency Medical Services ◽  
Symptom Onset ◽  
Temporal Trends ◽  
Medical Services ◽  
Factors Associated ◽  
Emergency Medical ◽  
Suspected Stroke

(1) Background: The benefit of acute ischemic stroke (AIS) treatment declines with any time delay until treatment. Hence, factors influencing the time from symptom onset to admission (TTA) are of utmost importance. This study aimed to assess temporal trends and risk factors for delays in TTA. (2) Methods: We included 1244 consecutive patients from 2015 to 2018 with suspected stroke presenting within 24 h after symptom onset registered in our prospective, pre-specified hospital database. Temporal trends were assessed by comparing with a cohort of a previous study in 2006. Factors associated with TTA were assessed by univariable and multivariable regression analysis. (3) Results: In 1244 patients (median [IQR] age 73 [60–82] years; 44% women), the median TTA was 96 min (IQR 66–164). The prehospital time delay reduced by 27% in the last 12 years and the rate of patients referred by Emergency medical services (EMS) increased from 17% to 51% and the TTA for admissions by General Practitioner (GP) declined from 244 to 207 min. Factors associated with a delay in TTA were stroke severity (beta−1.9; 95% CI–3.6 to −0.2 min per point NIHSS score), referral by General Practitioner (GP, beta +140 min, 95% CI 100–179), self-admission (+92 min, 95% CI 57–128) as compared to admission by emergency medical services (EMS) and symptom onset during nighttime (+57 min, 95% CI 30–85). Conclusions: Although TTA improved markedly since 2006, our data indicates that continuous efforts are mandatory to raise public awareness on the importance of fast hospital referral in patients with suspected stroke by directly informing EMS, avoiding contact of a GP, and maintaining high effort for fast transportation also in patients with milder symptoms.

scholarly journals Temporal Trends in Emergency Medical Services and General Practitioner Use for Acute Stroke After Australian Public Education Campaigns

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 3078-3080 ◽  
Author(s):  
Janet E. Bray ◽  
Judith Finn ◽  
Peter Cameron ◽  
Karen Smith ◽  
Lahn Straney ◽  
...  
Keyword(s):  
General Practitioner ◽  
Public Education ◽  
Acute Stroke ◽  
Emergency Medical Services ◽  
Temporal Trends ◽  
Medical Services ◽  
Emergency Medical ◽  
Education Campaigns

Factors influencing patient decision delay in activation of emergency medical services for suspected ST-elevation myocardial infarction

2020 ◽  
pp. 147451512095373
Author(s):  
Ahmad Alrawashdeh ◽  
Ziad Nehme ◽  
Brett Williams ◽  
Karen Smith ◽  
Michael Stephenson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Medical Services ◽  
Symptom Onset ◽  
St Elevation Myocardial Infarction ◽  
Medical Services ◽  
Factors Associated ◽  
Emergency Medical ◽  
History Of ◽  
St Elevation ◽  
At Home

Objective: The purpose of this study was to identify factors associated with time delay to emergency medical services for patients with suspected ST-elevation myocardial infarction. Methods: This observational study involved 1994 suspected ST-elevation myocardial infarction patients presenting to the emergency medical services in Melbourne, Australia, between October 2011–January 2014. Factors associated with delays to emergency medical services call of >1 h and emergency medical services self-referral were analyzed using multivariable logistic regression. Results: The time of symptom onset was reported for 1819 patients (91.2%), the median symptom onset-to-call time was 52 min (interquartile range=17–176). Of all emergency medical services calls, 17% were referred by healthcare professionals. Compared to self-referred patients, patients who presented to a general practitioner or hospital had higher odds of delay >1 h to emergency medical services activation (adjusted odds ratio 7.76; 95% confidence interval 5.10–11.83; and 8.02; 3.65–17.64, respectively). The other factors associated with emergency medical services call delays of >1 h were living alone, non-English speaking background, a history of substance abuse, less severe symptoms, symptom onset at home and at rest, and self-treatment. Emergency medical services self-referred patients were more likely to be older than 75 years, have a history of ischemic heart disease or revascularization, more severe symptoms, and symptom onset at home, with activity, during the weekends and out-of-hours. Conclusion: Almost one-fifth of emergency medical services calls for suspected ST-elevation myocardial infarction were healthcare referrals, and this was associated with increased delays. A wide range of factors could influence a patient’s decision to directly and rapidly seek emergency medical services. More efforts are needed to educate at-risk populations about early self-referral to the emergency medical services.

Abstract P138: Improving Emergency Medical Services Documentation of Time Last Known Well

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dot Bluma ◽  
Jessica Link Reeve ◽  
Susan M Godersky
Keyword(s):  
Emergency Medical Services ◽  
Symptom Onset ◽  
Systems Of Care ◽  
Onset Time ◽  
Reperfusion Therapy ◽  
Report Card ◽  
Medical Services ◽  
Emergency Department Physician ◽  
Measure Data ◽  
Emergency Medical

Background and Purpose: In a systems of care model, Emergency Medical Services (EMS) reporting a patient’s last known well (LKW) time to the receiving hospital is crucial for activation of the hospitals Acute Stroke Team. There is evidence that LKW is critical information for determining an acute ischemic stroke patient’s eligibility for advanced stroke therapy which includes intravenous Alteplase and/or mechanical endovascular reperfusion therapy. The 70 Wisconsin (WI) Coverdell Stroke Program (Coverdell) hospitals represent 80% of stroke admissions in WI. Coverdell developed a pre-arrival report card in Q3 2018 in which LKW was a tracked measure. Data entered into Get With The Guidelines®- Special Initiatives (SI) tab was collated to create the report card. After analysis of the data it was determined our performance improvement (PI) project would be to improve EMS’s documentation and reporting of time LKW. In Q3 2018, of those cases entered into the SI tab, EMS reporting a LKW time was 50%. Since LKW is not always obtainable, the project goal was set at 60%. Methods: We recognized implementation of this PI initiative would require a multi-prong approach. To assist EMS agencies in understanding the difference between LKW and symptom onset, we developed a document entitled, The Importance of an Accurate Last Known Well and Symptom Onset Time . A Coverdell team member attended WI’s EMS Physician Advisory Committee meetings where LKW data was discussed. In addition, an Emergency Department Physician hosted a webinar where the presentation highlighted the importance of documenting LKW. This webinar was recorded and sent to EMS agencies and hospitals. For loop closure and with the support of the WI’s EMS Director, LKW became a validated field for EMS in the WI Ambulance Run Data System. Findings: In Q2 2019 there was an improvement in documented LKW as evidenced by an increase to 59.2% The data has remained consistent even as more hospitals have begun to enter the data as demonstrated by the increasing N. Conclusion: The actions taken by the Coverdell program in educating EMS providers on the rationale and importance of LKW documentation was successful. However, additional efforts are required to reach and maintain the project goal of 60% with an additional stretch goal to 70%.

Factors Associated with Delay of Emergency Medical Services Activation in Patients with Acute Stroke

2021 ◽  
Vol 30 (1) ◽  
pp. 105426
Author(s):  
Ah Ram Seo ◽  
Hwan Song ◽  
Woon Jeong Lee ◽  
Kyu Nam Park ◽  
Jundong Moon ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Factors Associated ◽  
Emergency Medical

Factors Associated with Emergency Medical Services Scope of Practice for Acute Cardiovascular Events

2011 ◽  
Vol 16 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Ishmael Williams ◽  
Amy L. Valderrama ◽  
Patricia Bolton ◽  
April Greek ◽  
Sophia Greer ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Cardiovascular Events ◽  
Scope Of Practice ◽  
Medical Services ◽  
Factors Associated ◽  
Emergency Medical

scholarly journals PREHOSPITAL EMERGENCY MEDICAL SERVICES UTILIZATION FOR CRITICAL PATIENTS AND ITS DETERMINANTS IN THAILAND

2021 ◽  
Vol 56 (5) ◽  
pp. 514-523
Author(s):  
Songsak Poomsaidorn ◽  
Wongsa Laohasiriwong ◽  
Keopanha Soeung
Keyword(s):  
Emergency Medical Services ◽  
Linear Mixed Model ◽  
Medical System ◽  
Emergency Medical System ◽  
Medical Services ◽  
Factors Associated ◽  
Emergency Medical ◽  
Prehospital Emergency ◽  
Critical Patients ◽  
High Level

This research aimed to determine the situations and factors associated with prehospital emergency medical services (EMS) utilization for critical patients in Thailand. This cross-sectional study used the data of a survey conducted by the Information Technology for Emergency Medical System (ITEMS) of the National Institute of Emergency Medicine, Thailand. The survey collected the data among 1,145 participants using a structured questionnaire. The generalized linear mixed model (GLMM) was used to identify the factors associated with prehospital EMS utilization among critical patients when controlling the effects of covariates presenting adjusted OR and 95% confidence interval. Among 1,145 critical patients, 33.71 % reported using the prehospital EMS of the emergency medical system. Factors that were associated with prehospital EMS use had a high level of knowledge on prehospital EMS (adj. OR = 6.49; 95%CI: 3.78-11.12), high level of trust in quality and safety of prehospital EMS (adj. OR = 4.72; 95%CI: 3.50-6.36), low-moderate severity of perceived illness (adj. OR= 3.71; 95%CI: 2.54-5.42), critical condition occurred at workplace/building (adj. OR=3.57; 95%CI: 2.33-5.47), at home/residential building (adj. OR = 2.21; 95%CI: 1.37-3.58), had adequate services in the area (adj. OR= 1.94; 95%CI: 1.45-2.60), finished at least secondary school (adj. OR= 1.62; 95%CI: 1.11-2.37), less than 15km distance between scene and EMS service site (adj. OR= 1.47; 95%CI: 1.10-1.98), and were very satisfied with services (adj. OR = 1.15; 95%CI: 1.08-1.22) from the reasons mentioned.

Sign in / Sign up

Export Citation Format

Share Document