Brief Educational Intervention Improves Emergency Medical Services Stroke Recognition

Overview

Journal Stroke

Specialties Cardiology & Vascular Diseases
Neurology

Date 2019 Mar 29

PMID 30917754

Citations 20

Authors

J Adam Oostema

Todd Chassee

William Baer

Allison Edberg

Mathew J Reeves

Affiliations

Soon will be listed here.

Abstract

Background and Purpose- Recognition of stroke symptoms and hospital prenotification by emergency medical services (EMS) facilitate rapid stroke treatment; however, one-third of patients with stroke are unrecognized by EMS. To promote stroke recognition and quality measure compliant prehospital stroke care, we deployed a 30-minute online EMS educational module coupled with a performance feedback system in a single Michigan county. Methods- During a 24-month study period, a registry of consecutive EMS-transported suspected or unrecognized stroke cases was utilized to perform an interrupted time series analysis of the impact of the EMS education and feedback intervention. For each agency, we compared EMS stroke recognition and quality measure compliance rates, as well as emergency department performance and hospital outcomes during 12 preintervention months with performance in the remaining study months. Results- A total of 1805 EMS-transported cases met inclusion criteria; 1235 (68.4%) of these had ischemic or hemorrhagic strokes or transient ischemic attacks. There were no trends toward improvement in any outcome before the intervention. After the intervention, the EMS stroke recognition rate increased from 63.8% to 69.5% ( P=0.037). Prenotification increased from 60.9% to 77.3% ( P<0.001). Among patients with ischemic stroke/transient ischemic attack, there was a trend toward higher rates of tPA (tissue-type plasminogen activator) delivery (13.9%-17.7%; P=0.096) and a significant increase in tPA delivery within 45 minutes (5.7%-8.9%; P=0.042) after intervention. However, improvements in EMS recognition were limited to the first 3 months following intervention. Conclusions- A brief educational intervention was associated with improved EMS stroke recognition, hospital prenotification, and faster tPA delivery. Gains were primarily observed immediately following education and were not sustained through provision of performance feedback to paramedics.

Citing Articles

Prevalence and Determinants of Prehospital Impression of Stroke in Ischemic Stroke Patients.

Caffarelli M, Wood A, Crowe R, Amorim E, Kamel H, Kim A medRxiv. 2024; .

PMID: 39398987 PMC: 11469348. DOI: 10.1101/2024.09.25.24314407.

Evaluating the influence of a 3-min online video on the community knowledge of stroke in four Arab countries.

Iskandar K, Rahme D, Salameh P, Haddad C, Sacre H, Bahlol M Front Public Health. 2024; 12:1342490.

PMID: 38841682 PMC: 11151891. DOI: 10.3389/fpubh.2024.1342490.

Addressing Disparities in Acute Stroke Management and Prognosis.

Denny M, Rosendale N, Gonzales N, Leslie-Mazwi T, Middleton S J Am Heart Assoc. 2024; 13(7):e031313.

PMID: 38529656 PMC: 11179759. DOI: 10.1161/JAHA.123.031313.

Associations between emergency call stroke triage and pre-hospital delay, primary hospital admission, and acute reperfusion treatment among early comers with acute ischemic stroke.

Gude M, Valentin J, Christensen H, Mikkelsen S, Sovso M, Andersen G Intern Emerg Med. 2023; 18(8):2355-2365.

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Results of an international survey on the status of prehospital care.

Rudd A, Zhao J, Ford G, Melifonwu R, Abraham S, Fisher M Int J Stroke. 2023; 18(9):1084-1091.

PMID: 37154607 PMC: 10614170. DOI: 10.1177/17474930231177204.

References

Wiltsey Stirman S, Kimberly J, Cook N, Calloway A, Castro F, Charns M . The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci. 2012; 7:17. PMC: 3317864. DOI: 10.1186/1748-5908-7-17. View

Ramanujam P, Guluma K, Castillo E, Chacon M, Jensen M, Patel E . Accuracy of stroke recognition by emergency medical dispatchers and paramedics--San Diego experience. Prehosp Emerg Care. 2008; 12(3):307-13. DOI: 10.1080/10903120802099526. View

Medoro I, Cone D . An Analysis of EMS and ED Detection of Stroke. Prehosp Emerg Care. 2017; 21(4):476-480. DOI: 10.1080/10903127.2017.1294222. View

Eccles M, Grimshaw J, Campbell M, Ramsay C . Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care. 2003; 12(1):47-52. PMC: 1743658. DOI: 10.1136/qhc.12.1.47. View

Lin C, Peterson E, Smith E, Saver J, Liang L, Xian Y . Patterns, predictors, variations, and temporal trends in emergency medical service hospital prenotification for acute ischemic stroke. J Am Heart Assoc. 2012; 1(4):e002345. PMC: 3487363. DOI: 10.1161/JAHA.112.002345. View

Abboud M, Band R, Jia J, Pajerowski W, David G, Guo M . Recognition of Stroke by EMS is Associated with Improvement in Emergency Department Quality Measures. Prehosp Emerg Care. 2016; 20(6):729-736. DOI: 10.1080/10903127.2016.1182602. View

Rostanski S, Shahn Z, Elkind M, Liberman A, Marshall R, Stillman J . Door-to-Needle Delays in Minor Stroke: A Causal Inference Approach. Stroke. 2017; 48(7):1980-1982. PMC: 5708142. DOI: 10.1161/STROKEAHA.117.017386. View

Sauser K, Levine D, Nickles A, Reeves M . Hospital variation in thrombolysis times among patients with acute ischemic stroke: the contributions of door-to-imaging time and imaging-to-needle time. JAMA Neurol. 2014; 71(9):1155-61. DOI: 10.1001/jamaneurol.2014.1528. View

Ramsay C, Matowe L, Grilli R, Grimshaw J, Thomas R . Interrupted time series designs in health technology assessment: lessons from two systematic reviews of behavior change strategies. Int J Technol Assess Health Care. 2004; 19(4):613-23. DOI: 10.1017/s0266462303000576. View

10.

Bursac Z, Gauss C, Williams D, Hosmer D . Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008; 3:17. PMC: 2633005. DOI: 10.1186/1751-0473-3-17. View

11.

Fishe J, Crowe R, Cash R, Nudell N, Martin-Gill C, Richards C . Implementing Prehospital Evidence-Based Guidelines: A Systematic Literature Review. Prehosp Emerg Care. 2018; 22(4):511-519. DOI: 10.1080/10903127.2017.1413466. View

12.

Kim D, Nah H, Park H, Choi J, Kang M, Huh J . Impact of Prehospital Intervention on Delay Time to Thrombolytic Therapy in a Stroke Center with a Systemized Stroke Code Program. J Stroke Cerebrovasc Dis. 2016; 25(7):1665-1670. DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.011. View

13.

Oser C, McNamara M, Fogle C, Gohdes D, Helgerson S, Harwell T . Educational outreach to improve emergency medical services systems of care for stroke in Montana. Prehosp Emerg Care. 2010; 14(2):259-64. DOI: 10.3109/10903120903572335. View

14.

Oostema J, Chassee T, Reeves M . Emergency Dispatcher Stroke Recognition: Associations with Downstream Care. Prehosp Emerg Care. 2018; 22(4):466-471. DOI: 10.1080/10903127.2017.1405131. View

15.

Clawson J, Scott G, Gardett I, Youngquist S, Taillac P, Fivaz C . Predictive Ability of an Emergency Medical Dispatch Stroke Diagnostic Tool in Identifying Hospital-Confirmed Strokes. J Stroke Cerebrovasc Dis. 2016; 25(8):2031-42. DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.021. View

16.

Prabhakaran S, ONeill K, Stein-Spencer L, Walter J, Alberts M . Prehospital triage to primary stroke centers and rate of stroke thrombolysis. JAMA Neurol. 2013; 70(9):1126-32. DOI: 10.1001/jamaneurol.2013.293. View

17.

Ekundayo O, Saver J, Fonarow G, Schwamm L, Xian Y, Zhao X . Patterns of emergency medical services use and its association with timely stroke treatment: findings from Get With the Guidelines-Stroke. Circ Cardiovasc Qual Outcomes. 2013; 6(3):262-9. DOI: 10.1161/CIRCOUTCOMES.113.000089. View

18.

Emberson J, Lees K, Lyden P, Blackwell L, Albers G, Bluhmki E . Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014; 384(9958):1929-35. PMC: 4441266. DOI: 10.1016/S0140-6736(14)60584-5. View

19.

Oostema J, Konen J, Chassee T, Nasiri M, Reeves M . Clinical predictors of accurate prehospital stroke recognition. Stroke. 2015; 46(6):1513-7. DOI: 10.1161/STROKEAHA.115.008650. View

20.

Mould-Millman N, Meese H, Alattas I, Ido M, Yi I, Oyewumi T . Accuracy of Prehospital Identification of Stroke in a Large Stroke Belt Municipality. Prehosp Emerg Care. 2018; 22(6):734-742. DOI: 10.1080/10903127.2018.1447620. View