Brief Educational Intervention Improves Emergency Medical Services Stroke Recognition

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.

An Online Training Intervention on Prehospital Stroke Codes in Catalonia to Improve the Knowledge, Pre-Notification Compliance and Time Performance of Emergency Medical Services Professionals

“…We observed a progressive improvement in the compliance with the pre-notification register in 80% of the items, increasing from an overall 53% compliance score in 2014 to a 73% in 2015–2016, and 83% in 2017–2018 (Kirkpatrick level 3). This increment was greater than in another study performed in the USA [ 29 ] that achieved an increase from 60.9% to 77.3%; the last peak of 10% increase in our case could have been due to the start of RACECAT, a clinical trial focused on different transfer approaches for stroke patients. Pre-notifications systems have also been found effective in improving in-hospital times for therapy access [ 30 , 31 ].…”

Audit and Feedback in emergency: a systematic review and an Italian project to investigate and improve quality of care

“…[8][9][10]22 While 9 studies involved different medical departments, 6,[10][11][12]17,19,21,22,27 15 of them concerned only Emergency departments and/or paramedics. Most of articles proposed a multimodal approach: only 7 of them concerned exclusively A&F. [7][8][9][10][11]13,22 As it's shown in Table 2, 9 articles talked about measurements for infective pathologies (especially antibiotic stewardship), 7,8,12,13,16,17,21,22,29 6 of them treated cardiac arrest or cardiovascular emergency problems, 8,19,20,[25][26][27] 2 of them treated stroke, 15,24 3 ones were about laboratory analyses 10,18,28 and 4 of them treated any other fields (diabetic ketoacidosis, use of a prothrombin complex, etc. ), (Table 2).…”

Stroke systems of care in high-income countries: what is optimal?

“…13 However, educational interventions for emergency medical services can improve access to thrombolysis and several validated pre-hospital stroke screening tools used by paramedics can improve the accuracy of paramedic diagnosis. 14,15 Similar tools have been adapted for use by emergency medical services to identify and rapidly transfer patients with suspected stroke to hospitals able to provide thrombolysis 16 or for endovascular thrombectomy. 17 Such protocols are particularly relevant to provide pre-hospital triage, in areas underserved with specialist stroke services.…”