Is ambulance telephone triage using advanced medical priority dispatch protocols able to identify patients with acute stroke correctly?

Deakin, Charles D.; Alasaad, M; King, Phil; Thompson, Fizz

doi:10.1136/emj.2008.059733

Cited by 47 publications

(46 citation statements)

References 16 publications

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“…[7][8][9] If this is to be increased, it is necessary to identify those symptoms likely to have a high sensitivity in relation to a final diagnosis of stroke. The characteristics with the highest sensitivities were having no to only slight pre-stroke disability, and being alert.…”

Section: Discussionmentioning

confidence: 99%

“…4 However, delays in presentation and specialist assessment frequently prevent patients from receiving rtPA. Emergency medical dispatch sensitivity and positive predictive value (PPV) for identifying stroke is < 50%, [7][8][9] and this is compounded by long delays in patients accessing emergency medical services (EMSs). 10 Studies have shown that activation of the EMSs is the single most important factor in the rapid triage and treatment of acute stroke patients.…”

Section: Fundingmentioning

confidence: 99%

“…Published reports on the ability of EMDs to recognise stroke from callers' descriptions suggest that EMD sensitivity and PPV for identifying stroke are < 50%. [7][8][9] Therefore, improving the communication between EMDs and callers to increase the likelihood that stroke is recognised would promote the initiation of the pre-hospital pathways that are known to expedite patients' access to specialist assessment and treatment. 27 There is evidence to suggest that the EMSs are more likely to be contacted by the public for suspected stroke if the person's symptoms include speech problems, weakness, decreased level of consciousness and dizziness/loss of co-ordination.…”

Section: -18mentioning

confidence: 99%

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Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

Watkins

Jones

Leathley

et al. 2014

Programme Grants for Applied Research

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BackgroundRapid access to emergency stroke care can reduce death and disability by enabling immediate provision of interventions such as thrombolysis, physiological monitoring and stabilisation. One of the ways that access to services can be facilitated is through emergency medical service (EMS) dispatchers. The sensitivity of EMS dispatchers for identifying stroke is < 50%. Studies have shown that activation of the EMSs is the single most important factor in the rapid triage and treatment of acute stroke patients.ObjectivesTo facilitate recognition of stroke by emergency medical dispatchers (EMDs).DesignAn eight-phase mixed-methods study. Phase 1: a retrospective cohort study exploring stroke diagnosis. Phase 2: semi-structured interviews exploring public and EMS interactions. Phases 3 and 4: a content analysis of 999 calls exploring the interaction between the public and EMDs. Phases 5–7: development and implementation of stroke-specific online training (based on phases 1–4). Phase 8: an interrupted time series exploring the impact of the online training.SettingOne ambulance service and four hospitals.ParticipantsPatients arriving at hospital by ambulance with stroke suspected somewhere on the stroke pathway (phases 1 and 8). Patients arriving at hospital by ambulance with a final diagnosis of stroke (phase 2). Calls to the EMSs relating to phase 1 patients (phases 3 and 4). EMDs (phase 7).InterventionsStroke-specific online training package, designed to improve recognition of stroke for EMDs.Main outcome measuresPhase 1: symptoms indicative of a final and dispatch diagnosis of stroke. Phase 2: factors involved in the decision to call the EMSs when stroke is suspected. Phases 3 and 4: keywords used by the public when describing stroke and non-stroke symptoms to EMDs. Phase 8: proportion of patients with a final diagnosis of stroke correctly dispatched as stroke by EMDs.ResultsPhase 1: for patients with a final diagnosis of stroke, facial weakness and speech problems were significantly associated with an EMD code of stroke. Phase 2: four factors were identified – perceived seriousness; seeking and receiving lay or professional advice; caller’s description of symptoms and emotional response to symptoms. Phases 3 and 4: mention of ‘stroke’ or one or more Face Arm Speech Test (FAST) items is much more common in stroke compared with non-stroke calls. Consciousness level was often difficult for callers to determine and/or communicate. Phase 8: there was a significant difference (p = 0.003) in proportions correctly dispatched as stroke – before the training was implemented 58 out of 92 (63%); during implementation of training 42 out of 48 (88%); and after training implemented 47 out of 59 (80%).ConclusionsEMDs should be aware that callers are likely to describe loss of function (e.g. unable to grip) rather than symptoms (e.g. weakness) and that callers using the word ‘stroke’ or describing facial weakness, limb weakness or speech problems are likely to be calling about a stroke. Ambiguities and contradictions in dialogue about consciousness level arise during ambulance calls for suspected and confirmed stroke. The online training package improved recognition of stroke by EMDs. Recommendations for future research include testing the effectiveness of the Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) training package on the recognition of stroke across other EMSs in England; and exploring the impact of the early identification of stroke by call handlers on patient and process outcomes.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Discussionmentioning

confidence: 99%

Section: Fundingmentioning

confidence: 99%

Section: -18mentioning

confidence: 99%

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Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

Watkins

Jones

Leathley

et al. 2014

Programme Grants for Applied Research

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“…Previous research suggests that the CDSS is often oversensitive (it does not miss sick patients and therefore it is safe) but that it tends to 'over-triage' (it identifies 'too many' false positives because it is not specific enough). 47,48 Such studies acknowledge that it is difficult to devise a CDSS that has both high sensitivity and high specificity, and in a CDSS that has been designed for use by non-clinicians it is necessary -and somewhat inevitable -that NHS Pathways has high DISCUSSION AND CONCLUSIONS sensitivity. It is possible that NHS Pathways 13,15 may 'over-triage', particularly to ambulance services; however, more work is required to clearly understand this.…”

Section: Implications For Nhs 111 As a Standardised Servicementioning

confidence: 99%

The work, workforce, technology and organisational implications of the ‘111’ single point of access telephone number for urgent (non-emergency) care: a mixed-methods case study

Turnbull

Pope

Rowsell

et al. 2014

Health Services and Delivery Research

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Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: www.netscc.ac.uk/hsdr/ This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its proceeding programmes as project number 10/1008/10. The contractual start date was in August 2011. The final report began editorial review in November 2012 and was accepted for publication in April 2013. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. © Queen's Print...

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“…Emergency medical services (EMS) is the first medical contact for half of the acute stroke patients. Thus, they play an undeniable role in survival and prevention of complications in these patients [4]. Getting "the right patient to the right place in time" is the key to save lives and reduce disability caused by stroke [5].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Stroke Patients’ Status and Their Transfer Time by Emergency Medical Services to Valiasr Hospital in Arak City, Iran

Bahrampouri¹,

Khankeh²,

Dalvandi³

2016

HDQ

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Background: Stroke is a major cause of death and disability in the world and these complications can be decreased by competent emergency care. Emergency medical service (EMS) transfer half of the stroke patients to hospitals. This study aimed to determine diagnosis of status and transfer time of stroke patients by EMS to a main hospital (Valiasr) in Arak City. Materials and Methods:This study was a descriptive analytic study and conducted on 43 patients with a diagnosis of stroke that transferred by EMS to Valiasr Hospital in Arak City. Data were collected through a checklist which contained information about age, sex, type of accident, response time, scene time, transfer time, and total time from inpatients records and Emergency Center statistics. Regarding data analysis, descriptive statistical tests were performed by SPSS 19. Results:The mean(SD) age of patients was 73.7(3.8) years and 51.2% of them were women. The stroke diagnosis by EMS technicians was correct in 15(34.9%) cases. In 20(46.5%) cases, the diagnosis was wrong and in 8(18.6%) cases, there were not any diagnosis. The most common non-stroke condition was confusion. The mean response time and arrival time to location, transfer time, and total time were 6.9, 16.9, 9.1, and 35.3 minutes, respectively. In patients with correct diagnosis and wrong or no diagnosis, these mean times were 7, 17.1, 3.9, and 35.7 minutes and 6.9, 16.8, 9.7, and 33.5 minutes, respectively. Conclusion:The results of this study showed that an accurate diagnosis by EMS technicians could be an indicator for faster transfer of the patient to treatment center. It is recommended that more appropriate pre-hospital diagnosis tools of stroke be developed and handed to EMS staff, for more accurate diagnosis of strokes and their better treatment.

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Is ambulance telephone triage using advanced medical priority dispatch protocols able to identify patients with acute stroke correctly?

Cited by 47 publications

References 16 publications

Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

The work, workforce, technology and organisational implications of the ‘111’ single point of access telephone number for urgent (non-emergency) care: a mixed-methods case study

Assessment of Stroke Patients’ Status and Their Transfer Time by Emergency Medical Services to Valiasr Hospital in Arak City, Iran

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